Honan Nursing Management: ch.10 Patients With Chest and Lower Respiratory Tract Disorders

The nurse prescribes discharge instructions to the patient who was hospitalized for pneumonia which statement, if made by the patient, indicates good understanding of the instructions? A) " I will call my healthcare provider if I still feel tired after a week" B) " I will continue to do deep breathing exercising and coughing exercises at home" C) " I will schedule two appointments for the pneumonia and influenza vaccine" D) " I will cancel my follow up chest x-ray appointment if I feel better next week'

" I will continue to do deep breathing exercising in coughing exercises at home"

Which statement indicates a client understands teaching about the purified protein derivative (PPD) test for tuberculosis?

"Because I had a previous reaction to the test, this time I need to get a chest X-ray."

A patient taking isoniazid (INH) therapy for tuberculosis demonstrates understanding when making which statement?

"It is all right if I have a grilled cheese sandwich with American cheese."

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 be sleeping in another room"

The client asks the nurse to explain the reason for a chest tube insertion in treating a pneumothorax. Which is the best response by the nurse?

"The tube will drain air from the space around the lung."

A nurse is preparing dietary recommendations for a client with a lung abscess. Which statement would be included in the plan of care?

"You must consume a diet rich in protein, such as chicken, fish, and beans."

A patient who wears contact lenses is to be placed on rifampin for tuberculosis therapy. What should the nurse tell the patient?

"You should switch to wearing your glasses while taking this medication."

A patient has a Mantoux skin test prior to being placed on an immunosuppressant for the treatment of Crohn's disease. What results would the nurse determine is not significant for holding the medication?

0 to 4 mm

A nurse is assessing the injection site of a client who has received a purified protein derivative test. Which finding indicates a need for further evaluation?

15-mm induration

The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse, "How long will I have to be on these medications?" What should the nurse tell the patient?

6 to 12 months

Acute respiratory failure (ARF) occurs when oxygen tension (PaO2) falls to less than __________ mm Hg (hypoxemia) and carbon dioxide tension (PaCO2) rises to greater than __________ mm Hg (hypercapnia).

60; 50

A nurse is reviewing a client's X-ray. The X-ray shows an endotracheal (ET) tube placed 3/4" (2 cm) above the carina and reveals nodular lesions and patchy infiltrates in the upper lobe. Which interpretation of the X-ray is accurate?

A disease process is present.

The nurse educator is discussing aspiration with new nursing graduates. Which patient would the educator tell the nurses is at the greatest risk for aspiration?

A stroke patient with dysarthria

The ICU nurse is caring for a client who was admitted with a diagnosis of smoke inhalation. The nurse knows that this client is at increased risk for which of the following?

Acute respiratory distress syndrome

An hour after a thoracotomy, a patient complains of 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 is best for the nurse to take next? a. Milk the chest tube gently to remove any clots. b. Clamp the chest tube momentarily to check for the origin of the air leak. c. Assist the patient to deep breathe, cough, and use the incentive spirometer. d. administer the prescribed morphine.

Administer prescribed morphine

A patient diagnosed with active tuberculosis is homeless and has a history of alcohol abuse. Which intervention by the nurse will be the most effective in ensuring adherence with the treatment regimen?

Arrange for a daily meal and drug administration at a community center

After two months of tuberculosis treatment with isoniazid, rifampin,pyrazinamide, and ethambutol, he patient continues to have positive sputum smears for acid fast bacilli. Which action should the nurse take next?

Ask the patient whether the medication's have been taken as directed

A patient with bacterial pneumonia has coarse crackles and thick sputum. Which action would the nurse plant to promote airway clearance? A) restrict oral fluids during the day B) teach pursed lip, breathing technique C) assist the patient to splint the chest when coughing D) encourage the patient to wear nasal 02 cannula

Assist the patient to splint the chest when coughing

A nurse should include what instruction for the client during postural drainage?

Change positions frequently and cough up secretions.

When assessing a patient who has just arrived after an automobile accident the emergency department nurse notes, tachycardia, and absent breath sounds of lower, right lung for which intervention with the nurse prepare for the patient?

Chest tube connected to section

The nurse is collaborating with a community group to develop plans to reduce the incidence of lung cancer in the community. Which of the following would be most effective?

Classes at community centers to teach about smoking cessation strategies

Which term refers to lung tissue that has become more solid in nature as a result of a collapse of alveoli or an infectious process?

Consolidation

A client has undergone a left hemicolectomy for bowel cancer. Which activities prevent the occurrence of postoperative pneumonia in this client?

Coughing, breathing deeply, frequent repositioning, and using an incentive spirometer

The nurse assigned to a patient with possible pulmonary edema assesses the patient's lungs. Using auscultation, she identifies a characteristic breath sound diagnostic of pulmonary edema. Which of the following describes that breath sound?

Crackles in the lung bases

The nurse is auscultating the patient's lung sounds to determine the presence of pulmonary edema. What adventitious lung sounds are significant for pulmonary edema?

Crackles in the lung bases

An emergency room nurse is assessing a client who is complaining of dyspnea. Which sign would indicate the presence of a pleural effusion?

Decreased chest wall excursion upon palpation

A patient is diagnosed with hypoxemic hypoxia. The nurse knows that the etiology directs medical and nursing interventions. Which of the following is the cause?

Decreased oxygen diffusion into the tissues

An elderly client is diagnosed with pulmonary tuberculosis. Upset and tearful, he asks the nurse how long he must be separated from his family. Which nursing diagnosis is most appropriate for this client?

Deficient knowledge (disease process and treatment regimen)

The nurse is performing tuberculosis (TB) skin tests in a clinic that has many patients who have migrated to the United States. Which question is most for the nurse to ask before the skin test?

Did you receive the BCG bBacille Calmite Guerin vaccine for TB?

You are caring for a client who has been diagnosed with viral pneumonia. You are making a plan of care for this client. What nursing interventions would you put into the plan of care for a client with pneumonia?

Encourage increased fluid intake.

A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care?

Encouraging increased fluid intake

Patient who is taking rifampin for tuberculosis calls the clinic and reports having Orange discolored urine and tears. Which response by the nurse reflects accurate knowledge about the medication in the patient's illness?

Explain that orange, discolored urine and tears is normal and taking this medication

You are an occupational health nurse in a large ceramic manufacturing company. How would you intervene to prevent occupational lung disease in the employees of the company?

Fit all employees with protective masks.

A patient arrives in the emergency department after being involved in a motor vehicle accident. The nurse observes paradoxical chest movement when removing the patient's shirt. What does the nurse know that this finding indicates?

Flail chest

A victim of a motor vehicle accident has been brought to the emergency room. The patient is exhibiting paradoxical chest expansion and respiratory distress. Which of the following chest disorders should be suspected?

Flail chest

When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems?

Hypercapnia, hypoventilation, and hypoxemia

The nurse monitors a patient in the emergency department after chest tube placement for a hemopneumothorax. The nurse is concerned if which assessment finding is observed?

If 400 mL a blood in the collection chamber

The nurse assesses the patient with an pneumococcal pneumonia. Which findings with the nurse expect? A) increase tactile fremitus B) dry, nonproductive, cough C) hyperresonance to percussion D) a grating sound to auscultation

Increase tactile fremitus

The client with a lower respiratory airway infection is presenting with the following symptoms: fever, chills, dry hacking cough, and wheezing. Which nursing diagnosis best supports the assessment by the nurse?

Ineffective Airway Clearance

A nurse is caring for a client who was admitted with pneumonia, has a history of falls, and has skin lesions resulting from scratching. The priority nursing diagnosis for this client should be:

Ineffective airway clearance.

The nurse is performing discharge teaching with a patient who developed a pulmonary embolism after total knee surgery. The patient has been converted from heparin to sodium warfarin (Coumadin) anticoagulant therapy. What should the nurse tell the patient?

It is important to take the same brand of medicine.

A nurse is caring for a patient who has just had a thoracentisis. Which assessment information obtained by the nurse is a priority to communicate to the health care provider?

O2 saturdation 88%

The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment would best evaluate the effectiveness of the therapies? a. Observe for distended neck veins. b. Auscultate for crackles in the lungs. c. Palpate for heaves or thrills over the heart. d. Review hemoglobin and hematocrit values.

Observe for distended neck veins.

A patient experiences a chest wall contusion as a result of being struck in the chest with a baseball bat the emergency department nurse would be most concerned if which, finding was observed during the initial?

Paradoxical chest movement

A client is admitted to the facility with a productive cough, night sweats, and a fever. Which action is most important in the initial care plan?

Placing the client in respiratory isolation

Which action should the nurse plan to prevent aspiration in high-risk patients? A) turn on reposition a patient at least every two hours B) place a patient with altered consciousness in a side lying position C) insert a nasogastric tube for feeding a patient with high caloric needs D) increase, tactile fremitus is palpable over the right chest

Play say patient with altered consciousness in a side lying position

A client who has just had a triple-lumen catheter placed in his right subclavian vein complains of chest pain and shortness of breath. His blood pressure is decreased from baseline and, on auscultation of his chest, the nurse notes unequal breath sounds. A chest X-ray is immediately ordered by the physician. What diagnosis should the nurse suspect?

Pneumothorax

You are caring for a client with chronic respiratory failure. What are the signs and symptoms of chronic respiratory failure?

Progressive loss of lung function associated with chronic disease

Which information about prevention of lung disease should the nurse include for a patient with a 42 pack year history of cigarette smoking?

Resources for support in smoking cessation

You are caring for a client status post lung resection. When assessing your client you find that the bubbling in the water-seal chamber for the chest tubes is more than you expected. What should you check when bubbling in the water-seal chamber is excessive?

See if there are leaks in the system.

A patient is admitted with active tuberculosis. A nurse should question a healthcare providers order to discontinue airborne precautions unless which assessment finding is documented?

Sputum spears for acid fast bacilli are negative

A patient comes to the clinic with fever, cough, and chest discomfort. The nurse auscultates crackles in the left lower base of the lung and suspects that the patient may have pneumonia. What does the nurse know is the most common organism that causes community-acquired pneumonia?

Streptococcus pneumoniae

The healthcare provider writes an order for bacteriologic testing for a patient who has positive tuberculosis skin test. Which action should the nurse take?

Teach the patient about providing specimens for three consecutive days

A mediastinal shift occurs in which type of chest disorder?

Tension pneumothorax

The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clamped during transportation?

Tension pneumothorax

A patient with right lower lobe pneumonia has been treated with IV antibiotics for three days. Which assessment data obtained by the nurse indicates that the treatment has been effective?

The patient's white blood cell count (WBC) is 9000 /ul

While caring for a client with a chest tube, which nursing assessment would alert the nurse to a possible complication?

The tissues give a crackling sensation when palpated.

Employee health test results a tuberculosis skin test of 16mm induration in a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB. Which information should the occupational health nurse plan to teach the staff nurse?

Use and side effects of isoniazid

The nurse caring for a client with tuberculosis anticipates administering which vitamin with isoniazid (INH) to prevent INH-associated peripheral neuropathy?

Vitamin B6

Which vitamin is usually administered with isoniazid (INH) to prevent INH-associated peripheral neuropathy?

Vitamin B6

After assessment with a patient with pneumonia the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis? A) weak cough effort B) profuse green sputum C) respiratory rate of 28 breaths/minutes D) resting pulse oximetry of 85%

Weak cough effort

An older adult patient is receiving standard multi drug therapy for tuberculosis The nurse should notify the healthcare provider if the patient exhibit which of the findings?

Yellow tinged sclera

A client admitted with multiple traumatic injuries receives massive fluid resuscitation. Later, the physician suspects that the client has aspirated stomach contents. The nurse knows that this client is at highest risk for:

acute respiratory distress syndrome (ARDS).

A client who works construction and has been demolishing an older building is diagnosed with pneumoconiosis. This lung inflammation is most likely caused by exposure to:

asbestos.

The nurse supervises a student nurse who is assigned to take care of a patient with active tuberculosis (TB). Which action, if performed by the student nurse, would require an intervention by the nurse? a. The patient is offered a tissue from the box at the bedside. b. A surgical face mask is applied before visiting the patient. c. A snack is brought to the patient from the unit refrigerator. d. Hand washing is performed before entering the patient's room.

b. A surgical face mask is applied before visiting the patient.

A patient has just been admitted with probable bacterial pneumonia and sepsis. Which order should the nurse implement first? a. Chest x-ray via stretcher b. Blood cultures from two sites c. Ciprofloxacin (Cipro) 400 mg IV d. Acetaminophen (Tylenol) rectal suppository

b. Blood cultures from two sites

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 response by the nurse is best? a. "Would you like to talk to the hospital chaplain about your feelings?" b. "Can you tell me what it is that makes you think you will die so soon?" c. "Are you afraid that the treatment for your cancer will not be effective?" d. "Do you think that taking an antidepressant medication would be helpful?"

b. Can you tell me what it is that makes you think you will die so soon?

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? a. Listening to the patient's lung sounds several times during the shift b. Placing the patient on droplet precautions and in a private hospital room c. Increasing the oxygen flow rate to keep the oxygen saturation above 90% d. Monitoring patient serology results to identify the specific infecting organism

b. Placing the patient on droplet precautions and in a private hospital room

A patient with a pleural effusion is scheduled for a thoracentesis. Which action should the nurse take to prepare the patient for the procedure? a. Start a peripheral IV line to administer the necessary sedative drugs. b. Position the patient sitting upright on the edge of the bed and leaning forward. c. Obtain a large collection device to hold 2 to 3 liters of pleural fluid at one time. d. Remove the water pitcher and remind the patient not to eat or drink anything for 6 hours.

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

An occupational health nurse works at a manufacturing plant where there is potential exposure to inhaled dust. Which action, if recommended by the nurse, will be most helpful in reducing the incidence of lung disease? a. Treat workers with pulmonary fibrosis. b. Teach about symptoms of lung disease. c. Require the use of protective equipment. d. Monitor workers for coughing and wheezing.

c. Require the use of protective equipment.

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? a. The Mantoux test had an induration of 7 mm. b. The chest-x-ray showed infiltrates in the lower lobes. c. The patient is being treated with antiretrovirals for HIV infection. d. The patient has a cough that is productive of blood-tinged mucus.

c. The patient is being treated with antiretrovirals for HIV infection.

During discharge teaching, a nurse is instructing a client about pneumonia. The client demonstrates his understanding of relapse when he states that he must:

continue to take antibiotics for the entire 10 days.

A lobectomy is scheduled for a patient with stage I non-small cell lung cancer. The patient tells the nurse, "I would rather have chemotherapy than surgery." Which response by the nurse is most appropriate? a. "Are you afraid that the surgery will be very painful?" b. "Did you have bad experiences with previous surgeries?" c. "Surgery is the treatment of choice for stage I lung cancer." d. "Tell me what you know about the various treatments available."

d. "Tell me what you know about the various treatments available."

A patient with pneumonia has a fever of 101.4° F (38.6° C), a nonproductive cough, and an oxygen saturation of 88%. The patient complains of weakness, fatigue, and needs assistance to get out of bed. Which nursing diagnosis should the nurse assign as the highest priority? a. Hyperthermia related to infectious illness b. Impaired transfer ability related to weakness c. Ineffective airway clearance related to thick secretions d. Impaired gas exchange related to respiratory congestion

d. Impaired gas exchange related to respiratory congestion

A nurse assesses arterial blood gas results for a patient in acute respiratory failure (ARF). Which results are consistent with this disorder?

pH 7.28, PaO2 50 mm Hg

Which is a key characteristic of pleurisy?

pain

A client asks a nurse a question about the Mantoux test for tuberculosis. The nurse should base her response on the fact that the:

skin test doesn't differentiate between active and dormant tuberculosis infection.