Lower Respiratory Tract Infections and Disorders

A patient reports shortness of breath one day after a cholecystectomy. The nurse assesses the right lung sounds and notes dullness to percussion and decreased breath sounds. Which is the most probable reason for the assessment findings? Atelectasis Pneumonia Pneumothorax Tension pneumothorax

Atelectasis

Which intervention does the nurse perform 30 minutes before removing a chest tube from a patient? Prepare a sterile field that includes a petroleum dressing. Administer a pain medication to the patient. Clamp the chest tube. Ensure that the patient has nothing NPO

Administer a pain medication to the patient While removing the chest tube, the patient may have pain; therefore the nurse administers pain medication 30 to 60 minutes before the procedure. A sterile field should be prepared immediately before a sterile procedure. There is insufficient information to determine the status of the chest tube. It is highly unlikely that the chest tube is to be clamped because this increases pressure within the pleural space. The patient does not need to be NPO before the procedure.

When the patient with a persistent cough is diagnosed with pertussis, the nurse expects that which type of medication will be prescribed? Antibiotic Corticosteroid Bronchodilator Cough suppressant

Antibiotic Pertussis is caused by a gram-negative bacillus, Bordetella pertussis, and must be treated with antibiotics. Corticosteroids and bronchodilators are not helpful in reducing symptoms. Cough suppressants and antihistamines are ineffective and may induce coughing episodes with pertussis

The nurse is caring for a patient with a diagnosis of active tuberculosis (TB) and anticipates that which item will be included in the patient's treatment plan? Use directly observed therapy only in the initial phase. Administer drug therapy in three phases (initial, interim, and continuation). Initiate liver function tests (LFTs) 14 days after the start of treatment. Avoid alcohol because it increases the hepatotoxicity associated with isoniazid (INH).

Avoid alcohol because it increases the hepatotoxicity associated with isoniazid (INH). Alcohol must be avoided because it increases the hepatotoxicity of INH. Directly observed therapy must be continued through both phases in patients who are at risk for noncompliance with drug therapy. Drug therapy includes a two-phase process, with an initial and continuation phase. Baseline LFTs are done before treatment is begun and then monitored monthly.

The nurse is assessing a patient who is hospitalized with suspected tuberculosis (TB) and expects which initial manifestations? Select all that apply. Dry cough that becomes productive Dyspnea Malaise Hemoptysis Low-grade fever Unexplained weight loss

Dry cough that becomes productive Malaise Low-grade fever Unexplained weight loss Symptoms of pulmonary TB usually do not develop until 2 to 3 weeks after infection or reactivation. The primary manifestation is an initial dry cough that often becomes productive with mucoid or mucopurulent sputum. Active TB disease may initially present with constitutional symptoms (e.g., fatigue, malaise, anorexia, unexplained weight loss, low-grade fevers, night sweats). Dyspnea is a late symptom that may signify considerable pulmonary disease or a pleural effusion. Hemoptysis, which occurs in less than 10% of patients with TB, is also a late sign.

Which type of chest surgery is indicated for a patient with chest trauma? Pneumonectomy Segmental resection Exploratory thoracotomy Lung volume reduction surgery

Exploratory thoracotomy An exploratory thoracotomy is an incision into the thorax to look for injured or bleeding tissues. It is indicated for a patient with chest trauma. Pneumonectomy is indicated for a patient with lung cancer. Segmental resection is indicated for a patient with bronchiectasis. Lung volume reduction surgery is indicated for a patient with advanced bullous emphysema.

A patient who is being treated at home for pneumonia reports fatigue to the home health nurse. Which instructions does the nurse provide for the patient? Select all that apply. Get adequate rest. Restrict fluid intake. Avoid alcohol and smoking. Resume work to build strength. Take every dose of the prescribed antibiotic

Get adequate rest Avoid alcohol and smoking Take every dose of the prescribed antibiotic To ensure complete recovery after pneumonia, the patient should be advised to rest, avoid alcohol and smoking, and take every dose of the prescribed antibiotic. The patient should not resume work if feeling fatigued and should be encouraged to drink plenty of fluids during the recovery period

The nurse is caring for a patient admitted to the hospital with pneumonia. Upon assessment, the nurse notes a temperature of 101.4° F, a productive cough with yellow sputum, and a respiratory rate of 20 breaths/minute. Which is an appropriate nursing diagnosis? Hyperthermia related to infectious illness Ineffective thermoregulation related to chilling Ineffective breathing pattern related to pneumonia Ineffective airway clearance related to thick secretions

Hyperthermia related to infectious illness Because the patient has spiked a temperature and has a diagnosis of pneumonia, the logical nursing diagnosis is hyperthermia related to infectious illness. There is no evidence of a chill, and the patient's breathing pattern is within normal limits at 20 breaths/minute. There is no evidence of ineffective airway clearance from the information given because the patient is expectorating sputum

Which clinical manifestation does the nurse expect to find during the respiratory assessment of a patient with pneumonia? Hyperresonance on percussion Vesicular breath sounds in all lobes Increased fremitus Coarse rhonchi in all lobes on auscultation

Increased fremitus

A patient's initial purified protein derivative (PPD) skin test result is positive. A repeat skin test is also positive. No signs or symptoms of tuberculosis or allergies are evident. Which medication therapy does the nurse anticipate will be prescribed? Penicillin Isoniazid (INH) Theophylline INH plus an antibiotic

Isoniazid (INH) The standard treatment regimen for latent tuberculosis infection (LTBI) is nine months of daily isoniazid. It is an effective and inexpensive drug that the patient can take orally. Penicillin and theophylline would not be prescribed for the treatment of TB exposure. INH plus an antibiotic would not likely be prescribed for this scenario.

A patient with a diagnosis of chylothorax is prescribed octreotide. Which outcome does the nurse expect after the treatment? Adequate hydration Adequate pain control Reduced risk of hypoxemia Reduced flow of lymphatic fluid

Reduced flow of lymphatic fluid Chylothorax is a type of chest injury that is associated with the accumulation of fluid in the pleural space. Octreotide acts like the natural hormone somatostatin, which behaves as a vasoconstrictor and reduces the flow of lymphatic fluid into the pleural space. The patient with chylothorax will not need hydration and IV fluids. The nurse administers analgesia for adequate pain control. Octreotide does not reduce the risk of hypoxemia.

Which condition in a patient with chest trauma requires treatment with positive pressure ventilation? Flail chest Cardiac tamponade Hemopneumothorax Tension pneumothorax

Flail chest Flail chest results in a loss of chest stability as a result of fracture of the ribs. The nurse should stabilize the flail segment with positive pressure ventilation (intubation and mechanical ventilation as needed). The nurse performs needle decompression to treat cardiac tamponade. The patient with a hemopneumothorax or tension pneumothorax requires treatment with chest tube drainage, and positive pressure ventilation aggravates the patient's condition

The nurse determines that additional discharge teaching is needed for a patient with pneumonia when the patient makes which statement? "Improvement usually occurs in three to five days after taking the prescribed antibiotics." "Breathing exercises may help prevent future infections." "I should take antibiotics for all upper respiratory infections." "I will seek medical attention if I develop a fever or productive cough."

I should take antibiotics for all upper respiratory infections Antibiotics are not indicated for all upper respiratory tract infections, such as viral infections, because they have side effects and promote antibiotic resistance. It is important for the patient to continue with coughing and deep breathing exercises for at least six weeks, until all of the infection has cleared from the lungs. The patient should take all medications as prescribed and seek medical attention for signs or symptoms of a new infection

A patient with a 10-year history of regular (three beers per week) alcohol consumption began taking rifampin to treat tuberculosis (TB). During a follow-up visit one week after starting the medication, the patient tells the nurse, "In the last week, my urine turned orange, and I am very worried about it." How does the nurse respond? Inform the patient that it is one of the side effects of the medication. Recognize that the TB may have spread to the liver; further medical consultation is required. Recognize that the liver may be damaged from alcohol consumption; a liver function test should be performed. Instruct the patient to stop taking the medication immediately and consult the health care provider.

Inform the patient that it is one of the side effects of the medication A nurse should be aware of some of the common side effects of antitubercular drugs like rifampin, one of which is orange discoloration of body fluids such as urine, sweat, tears, and sputum. It may also cause hepatitis. Liver damage can lead to jaundice, which usually presents as yellowish discoloration of urine and sclera. However, it is highly unlikely that TB has spread to the liver. The alcohol intake of the patient is within normal limits, so it is not correct to say that alcohol may have damaged the liver. It is also inappropriate to advise the patient to stop taking antitubercular drugs.

The nurse provides care for a patient with a chest tube flutter valve in place and recalls which information about the device? It allows patient mobility. It is used to evacuate fluid from the pleural space. It is attached to the internal end of the chest tube. It opens when the chest pressure is less than atmospheric pressure

It allows patient mobility A flutter valve (also called the Heimlich valve) is used to remove air from the pleural space. It allows for patient mobility because the smaller drainage bag can be hidden under the clothes while the patient ambulates. The valve evacuates air, not fluid, from the pleural space. It is attached to the external end of the chest tube. A flutter valve opens whenever the pressure in the chest is greater than the atmospheric pressure.

The nurse cares for a patient with a diagnosis of tuberculosis. Which assessment finding best indicates that the patient has been following the prescribed treatment plan? Negative sputum cultures Clear breath sounds bilaterally Decrease in the number of coughing episodes Patient report of experiencing less fatigue

Negative sputum cultures A patient's sputum is expected to convert to negative within three months of the beginning of treatment. If it does not, the patient is either not taking the medication or has drug-resistant organisms. Bilaterally clear breath sounds, a decrease in coughing, and less fatigue are good indications that the patient is following the prescribed plan, but they are not as confirmatory as negative sputum cultures

The nurse is monitoring a patient who is undergoing a thoracentesis for recurrent pleural effusion. Which assessment finding is of concern? Removal of 1000 mL of pleural fluid Restlessness and sudden onset of dyspnea SpO2 reading of 96% while on 2 L/minute of oxygen Patient report of pressure at the needle insertion site

Restlessness and sudden onset of dyspnea During and after a thoracentesis, monitor the patient's vital signs and pulse oximetry, and observe the patient for any manifestations of respiratory distress, which may indicate a possible complication, such as pneumothorax or pulmonary edema. It is not unusual to remove up to 1000 to 1200 mL of pleural fluid at one time. The SpO2 reading of 96% and patient report of pressure at the needle insertion site are not abnormal findings

Which is a primary clinical manifestation of flail chest in an unconscious patient? Cyanosis Shallow respirations Neck vein distention Decreased heart rate

Shallow respirations An unconscious patient who has fractures of consecutive ribs will have rapid and shallow respirations. A flail chest is usually apparent on physical examination. The patient has rapid, shallow respirations and tachycardia. Movement of the thorax is asymmetric and uncoordinated. The patient may ventilate poorly and try to splint the chest to assist with breathing. Cyanosis may occur in a patient with impaired respirations; however, it is not an evident symptom of flail chest. The patient with flail chest will not have edema, so distention of the neck is not a manifestation. The patient with flail chest will have an increased heart rate (tachycardia)

Which nursing intervention assists a patient with pneumonia in managing thick secretions and fatigue? Performing postural drainage every hour Providing analgesics as prescribed to promote patient comfort Administering oxygen as prescribed to maintain optimal oxygen saturation levels Teaching the patient how to cough effectively and expectorate secretions

Teaching the patient how to cough effectively and expectorate secretions Although several interventions may help the patient expectorate mucus, the nursing interventions should focus on teaching the patient how to cough effectively and expectorate secretions. Postural drainage may help to loosen the secretions. Administering analgesics does not help to manage thick secretions. Administering oxygen also does not help the patient manage secretions

The nurse provides education for a group of nursing students about acute bronchitis and includes which information? Typically, there are infiltrates seen on the chest x-ray. If symptoms last longer than two weeks, patients are advised to see their health care provider (HCP). Therapy is mainly supportive. Egophony may be auscultated

Therapy is mainly supportive Acute bronchitis is usually self-limiting, and the treatment for acute bronchitis is supportive. Chest x-rays will differentiate acute bronchitis from pneumonia. With bronchitis, no consolidation or infiltrates will be seen on an x-ray as there is with pneumonia. If patients with acute bronchitis develop a fever, have difficulty breathing, or have symptoms last longer than four weeks, they should see their HCP. Because there is no consolidation, egophony would not be auscultated. Egophony is an increased resonance of voice sounds heard when auscultating the lungs, often caused by lung consolidation and fibrosis. It is caused by the enhanced transmission of high-frequency sound across fluid, such as in abnormal lung tissue, with lower frequencies filtered out

The nurse is preparing a community education session related to the increased incidence of tuberculosis (TB) among the city's residents. The nurse identifies that which populations are most at risk for the disease? Select all that apply. Workers at a nearby prison Elderly adults who attend activities at a local senior center Adults who are homeless Children who attend a preschool three days a week Middle-aged adults who live in the inner-city neighborhood Immigrants from an underdeveloped country who live in temporary housing in the city

Workers at a nearby prison Adults who are homeless Middle-aged adults who live in the inner-city neighborhood Immigrants from an underdeveloped country who live in temporary housing in the city TB occurs disproportionately in the poor, underserved, and minorities. People most at risk include the homeless, residents of inner-city neighborhoods, foreign-born people, those living or working in institutions (long-term care facilities, prisons, shelters, hospitals), IV-injecting drug users, those with overcrowded living conditions and less-than-optimal sanitation, and those with poor access to health care. Immunosuppression from any cause (e.g., HIV infection, cancer, long-term corticosteroid use) increases the risk for active TB infection. Elderly adults who attend activities at a local senior center and children who attend a preschool three days a week do not have an increased risk of the disease.

The nurse collaborates with the health care team to arrange for home care for a patient with pulmonary tuberculosis (TB). Of the family members who live with the patient, which one is at the greatest risk for contracting the disease? A 15-year-old child who has a history of asthma A 25-year-old daughter who is seven months pregnant A 50-year-old spouse who is 20 pounds overweight A 75-year-old parent who takes prednisone

A 75-year-old parent who takes prednisone The patient's parent would be most susceptible to TB as a consequence of advanced age and immunosuppression by the corticosteroid. A history of asthma, obesity, and pregnancy do not increase the risk of contracting TB.

The nurse prepares staff education related to lung transplantation and includes which information? Select all that apply. Acute rejection typically occurs in the first two to three weeks after surgery. Accurate diagnosis of rejection is by transtracheal biopsy. Immunosuppressive therapy usually includes a two-drug regimen. Cytomegalovirus (CMV) is a common causative agent of infection after lung transplant. During the first year after transplantation, viral pneumonia is the most common type of infection. Lung transplant recipients usually receive higher levels of immunosuppressive therapy than other organ recipients.

Accurate diagnosis of rejection is by transtracheal biopsy Cytomegalovirus (CMV) is a common causative agent of infection after lung transplant Lung transplant recipients usually receive higher levels of immunosuppressive therapy than other organ recipients Lung transplant recipients are at high risk for multiple complications. Accurate diagnosis of rejection is by transtracheal biopsy. Infections are the leading cause of death at all time points after lung transplant. Bacterial bronchitis and pneumonia are the most common infections. CMV, fungi, viruses, and mycobacteria are also causative agents. Lung transplant recipients usually receive higher levels of immunosuppressive therapy than other organ recipients. Acute rejection is fairly common in lung transplantation; it typically occurs in the first 5 to 10 days after surgery. Immunosuppressive therapy is usually a three-drug regimen. Bacterial bronchitis and pneumonia are the most common postoperative infections

When caring for a patient with pertussis, which intervention does the nurse prioritize? Administering antibiotic therapy Administering an antihistamine at bedtime Teaching the patient how to use a bronchodilator Instructing the patient to use cough suppressants

Administering antibiotic therapy The treatment is macrolide (erythromycin, azithromycin [Zithromax]) antibiotics to minimize symptoms and prevent the spread of the disease. For the patient who cannot take macrolides, trimethoprim/sulfamethoxazole is used. Cough suppressants and antihistamines should not be used because they are ineffective and may induce coughing episodes. Corticosteroids and bronchodilators are not useful in reducing symptoms

When caring for a patient with pertussis, which intervention does the nurse prioritize? Administering antibiotic therapy Administering an antihistamine at bedtime Teaching the patient how to use a bronchodilator Instructing the patient to use cough suppressants

Administering antibiotic therapy The treatment is macrolide (erythromycin, azithromycin [Zithromax]) antibiotics to minimize symptoms and prevent the spread of the disease. For the patient who cannot take macrolides, trimethoprim/sulfamethoxazole is used. Cough suppressants and antihistamines should not be used because they are ineffective and may induce coughing episodes. Corticosteroids and bronchodilators are not useful in reducing symptoms.

While obtaining a health history for a patient with suspected tuberculosis (TB), the nurse expects which early signs or symptoms of the disease? Select all that apply. Anorexia Fatigue Dizziness Night sweats Chest tightness

Anorexia Fatigue Night sweats Symptoms of pulmonary TB usually do not develop until 2 to 3 weeks after infection or reactivation. The primary manifestation is an initial dry cough that often becomes productive with mucoid or mucopurulent sputum. Active TB disease may initially present with constitutional symptoms (e.g., fatigue, malaise, anorexia, unexplained weight loss, low-grade fevers, night sweats). Dyspnea is a late symptom that may signify considerable pulmonary disease or a pleural effusion. Hemoptysis, which occurs in less than 10% of patients with TB, is also a late sign. Dizziness and chest tightness are not symptoms associated with TB

A patient presents with a lung abscess. The nurse expects that which intervention will be included in the patient's treatment plan? Postural drainage Antibiotic therapy Chest physiotherapy Fluid restriction

Antibiotic therapy Because there are mixed bacteria in a lung abscess, starting a broad-spectrum antibiotic is the appropriate treatment option. Postural drainage and chest physiotherapy are not recommended because they may cause spillage of the infection to other bronchi and spread the infection. Reducing fluid intake is not advisable; instead, adequate fluid intake is recommended

A patient with a spontaneous pneumothorax has a chest tube in place that is attached to a chest drainage unit (CDU) with no suction being applied. The water level in the water-seal chamber is fluctuating. Which action does the nurse take? Notify the health care provider immediately. Decrease the amount of water in the water-seal chamber. Continue to monitor and document the respiratory status. Clamp the chest tube as close as possible to the insertion site.

Continue to monitor and document the respiratory status In a CDU that is not attached to suction, the fluid in the water-seal chamber rises when the patient inhales and falls when the patient exhales. This is a normal finding. The absence of fluctuations may indicate an obstruction in the system. The nurse must continually check the function of the CDU and assess respiratory status at least every four hours. There is no need to notify the health care provider or decrease the amount of water in the water-seal chamber because the chest tube system is functioning normally. The chest tube should not be clamped; doing so could cause a tension pneumothorax.

The nurse is providing postoperative care for a patient following a left pneumonectomy. Which is an appropriate nursing intervention? Determining chest tube drainage every hour for the first 24 hours Positioning the patient on the back or the right side Auscultating the lung sounds on the left side every 15 minutes Encouraging range-of-motion exercises on the left upper extremity

Encouraging range-of-motion exercises on the left upper extremity A pneumonectomy is the removal of an entire lung. Range-of-motion exercises performed on the affected upper extremity will prevent edema and encourage circulation to the lung space to promote healing. A patient who has had a pneumonectomy may have a clamped chest tube postoperatively, so there will not be any drainage. Fluid will gradually fill the space where the lung has been removed. The patient should be positioned on the operative side to facilitate the expansion of the remaining lung. There will not be lung sounds on the operative side because the entire lung has been removed

A patient with chest wall trauma has diminished breath sounds on the affected side, dyspnea, and bleeding in the chest wall. A chest tube is inserted immediately after the injury. Which diagnosis does the nurse expect to find in the patient's medical record? Flail chest Chylothorax Cardiac tamponade Hemopneumothorax

Hemopneumothorax A hemothorax is an accumulation of blood in the pleural space from injury to the chest wall, diaphragm, lung, blood vessels, or mediastinum. When it occurs with pneumothorax, it is called a hemopneumothorax. A hemopneumothorax in a patient with a chest wall injury is manifested by diminished breath sounds on the affected side and dyspnea and bleeding in the chest wall. Flail chest is a thoracic injury associated with fracture of the ribs. Chylothorax is a thoracic injury and is characterized by the presence of lymph in the pleural space. Cardiac tamponade is associated with increased pleural fluid in the pericardium, which increases pressure on the heart

The nurse provides education for a patient with human immunodeficiency virus (HIV) who is diagnosed with an infection of the lungs caused by Candida albicans. Which statement made by the patient indicates the need for further teaching? "I will be given amphotericin B to treat the fungus." "I contracted this fungus because I am immunocompromised." "I need to be isolated from my family and friends so that they won't get the infection." "The effectiveness of my therapy can be monitored with fungal serology titers."

I need to be isolated from my family and friends so that they won't get the infection C. albicans is an organism that causes a fungal infection. Pulmonary fungal infections are acquired by inhaling spores. They are not transmitted from person to person. The patient does not have to be placed in isolation. Because the patient is immunocompromised (because of HIV), the patient is likely to have a serious infection, so the treatment will likely include IV amphotericin B. The effectiveness of the therapy can be monitored with fungal serology titers.

Which instructions does the nurse provide to a patient with acute bronchitis? Select all that apply. Increase oral fluid intake. Avoid secondhand smoke. Maintain a 30-degree head elevation when in bed. Avoid throat lozenges because they may induce coughing. Eat a spoonful of honey to help relieve cough

Increase oral fluid intake Avoid secondhand smoke Eat a spoonful of honey to help relieve cough The goal of treatment is to relieve symptoms and prevent pneumonia. Treatment is supportive. It includes encouraging oral fluid intake. Honey may help relieve cough. The nurse should encourage patients not to smoke, to avoid secondhand smoke, and to wash their hands often. The patient should be positioned in an upright sitting position (high Fowler's) with the head slightly flexed. Throat lozenges may help relieve cough.

The nurse provides which information about the water-seal chamber on a chest drainage unit (CDU) when educating a group of nursing students? It contains 2 cm of water. It acts as a two-way valve. It receives fluid and air from the pleural space. It applies suction to the chest drainage system

It contains 2 cm of water The water-seal chamber is the second chamber of the chest drainage system. It contains 2 cm of water, which acts as a one-way valve. The first chamber of the drainage system receives fluid and air from the pleural space. The third chamber applies suction to the chest drainage system. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question

The nurse is caring for a patient who receives enteral feeding through a nasogastric (NG) tube. Which actions does the nurse perform to prevent aspiration in this patient? Select all that apply. Monitor gastric residual volumes. Assess the gag reflex before giving foods or fluids by mouth. Administer the initial feeding at a slow rate. Elevate the head of the bed to at least 30 degrees. Encourage the patient to sit upright for all meals

Monitor gastric residual volumes. Assess the gag reflex before giving foods or fluids by mouth. Elevate the head of the bed to at least 30 degrees. Encourage the patient to sit upright for all meals Aspiration pneumonia results from the abnormal entry of material from the mouth or stomach into the trachea and lungs. Although feeding tubes are small, any interruption in the integrity of the lower esophageal sphincter can allow reflux of gastric contents. Conditions that increase the risk for aspiration include the insertion of NG tubes with or without enteral feeding. Gastric residual volumes should be monitored to determine how well the patient is tolerating the feeding. The nurse should assess for a gag reflex before giving food or fluids by mouth. For the patient who has difficulty swallowing and needs aid in eating, drinking, and taking medication to prevent aspiration, the nurse should elevate the patient's head of the bed to at least 30 degrees and have the patient sit up for all meals. The health care provider will prescribe the rate at which the enteral feeding is to be administered.

A patient is diagnosed with pulmonary embolism. Which interventions are appropriate to be included in the patient's plan of care? Select all that apply. Monitor the patient's hemoglobin level. Keep the patient on bed rest in a supine position. Maintain an IV line for medications and fluid therapy. Instruct the patient to refrain from coughing and deep-breathing exercises. Monitor for complications of anticoagulant therapy

Monitor the patient's hemoglobin level Maintain an IV line for medications and fluid therapy Monitor for complications of anticoagulant therapy Pulmonary embolism requires prompt treatment. The nurse should monitor the patient's hemoglobin level and assess the patient for bleeding. An IV line should be maintained for medications and fluid therapy. Anticoagulants and fibrinolytics may have adverse effects, and the nurse should monitor the patient for side effects. The patient typically is placed in the semi-Fowler's position to assist in breathing. The patient should be encouraged to cough and perform deep-breathing exercises

A patient receives a prescription for amphotericin B. The nurse identifies that the medication is being given to treat which respiratory condition? Lung abscess Necrotizing pneumonia Pertussis Pulmonary fungal infection

Pulmonary fungal infection Amphotericin B is the standard therapy for treating serious systemic fungal infections. It must be given IV to achieve adequate blood and tissue levels because the gastrointestinal tract does not absorb it well. For a lung abscess, clindamycin is the first-line therapy because of its effectiveness against Staphylococcus and anaerobic organisms. The treatment for necrotizing pneumonia includes long-term antibiotic therapy. The treatment for pertussis is macrolide (erythromycin, azithromycin [Zithromax]) antibiotics to minimize symptoms and prevent the spread of the disease.

The nurse cares for a 75-year-old patient with pneumonia and identifies that the patient is at risk for which complications? Select all that apply. Sepsis Pleurisy Bronchitis Encephalitis Pleural effusion Congestive heart failure

Sepsis Pleurisy Pleural effusion Complications from pneumonia develop more often in older adults and those with underlying chronic diseases. These include sepsis/septic shock, which can occur when bacteria within the alveoli enter the bloodstream; pleurisy (an inflammation of the pleura); and pleural effusion (fluid in the pleural space). Bronchitis and encephalitis are not complications. Congestive heart failure is not directly known to be a complication of pneumonia.

A patient presents to the emergency room with severe dyspnea, tachycardia, tracheal deviation, and neck vein distention. Which condition does the nurse suspect? Flail chest Hemothorax Cardiac tamponade Tension pneumothorax

Tension pneumothorax Tension pneumothorax is the result of increased air in the pleural space; it causes shifting of bodily organs and an increase in intrathoracic pressure. Manifestations of a tension pneumothorax include severe dyspnea, marked tachycardia, tracheal deviation, decreased or absent breath sounds on the affected side, neck vein distention, cyanosis, and profuse diaphoresis. Hemothorax is an accumulation of blood in the pleural space; the patient usually presents with dyspnea, diminished breath sounds, dullness to percussion, and shock, depending on blood loss. Flail chest is a fracture of two or more ribs; the patient presents with paradoxical movement of the chest wall and respiratory distress. Cardiac tamponade occurs when blood collects in the pericardial sac; the patient presents with muffled, distant heart sounds, hypotension, neck vein distension, and increased central venous pressure

One week after a thoracotomy, a patient with a chest tube attached to a chest drainage unit (CDU) experiences an air leak in the system. Which assessment finding warrants follow-up nursing interventions? The water-seal chamber contains 5 cm of sterile water. There is no new drainage in the collection chamber. The dressing over the chest tube insertion site is loose. The patient has a small pneumothorax

The dressing over the chest tube insertion site is loose If the dressing at the chest tube insertion site is loose, an air leak will occur and will need to be sealed. The water-seal chamber usually has 2 cm of water, but having more water will not contribute to an air leak; it should not be drained from the CDU. No new drainage does not indicate an air leak but may indicate that the chest tube is no longer needed. If there is a pneumothorax, the chest tube should remove the air

The nurse suspects which cause of increased bubbling in the water-seal chamber of a patient's chest drainage unit (CDU)? The patient has complete lung reexpansion. The patient has a bronchopleural leak. The patient has a pleural friction rub. The patient has an infection at the drainage site

The patient has a bronchopleural leak If bubbling increases, there may be an air leak in the drainage system or a leak from the patient (bronchopleural leak). Lung expansion in the water-seal chamber is indicated by tidaling. A pleural friction rub is the squeaking or grating sound of the pleural linings rubbing together. It occurs when the pleural layers are inflamed and have lost their lubrication. The presence of inflammation, erythema at the site, or an increase in white blood cell count indicates infection.

After connecting a patient's chest tube to a dry suction system, which action does the nurse take next? Verify that the float has disappeared from the window of the chest drainage unit (CDU). Turn the suction dial on the CDU to -20 cm H2O pressure. Depress the high-negativity vent. Briefly and methodically move clamps down the chest tube to assess for air leaks

Turn the suction dial on the CDU to -20 cm H2O pressure After connecting the patient to the system, the nurse should turn the dial on the chest drainage system to the amount ordered (generally -20 cm H2O pressure). The nurse then should connect the suction tubing to the wall suction source and increase the suction until the float appears in the window of the CDU. If ordered to decrease the suction, the nurse would turn the dial down, depress the high-negativity vent, and assess for a rise in the water level of the water-seal chamber. Brief and methodical clamping should take place if an air leak is suspected; there is no information given that warrants this action.

Which type of procedure allows the health care provider to manipulate instruments passed into the pleural space? Decortication Segmental resection Exploratory thoracotomy Video-assisted thoracoscopic surgery

Video-assisted thoracoscopic surgery Video-assisted thoracoscopic surgery allows the surgeon to manipulate instruments passed into pleural space. Decortication, segmental resection, and exploratory thoracotomy do not allow the surgeon to manipulate instruments passed into pleural space

Which surgical lung procedure involves the removal of a small, localized lesion that occupies only part of a segment? Pleurodesis Wedge resection Pleural biopsy Thoracentesis

Wedge resection A wedge resection is the removal of a small, localized lesion that occupies only part of a segment. Pleurodesis is the surgical procedure that helps in the adhesion of the visceral and parietal pleura in the patient who has a pneumothorax. Pleural biopsy is a procedure in which a sample of pleural cells is examined for tumors. Thoracentesis is a procedure that is performed to drain the fluid from the pleural space.

A patient received antibiotic treatment for bacterial pneumonia. The nurse determines that the levofloxacin therapy has not been effective after noting which indicator? Temperature 99.7° F Increased respiratory rate Adventitious lung sounds White blood cell count 16,000/μL

White blood cell count 16,000/μL The normal white blood cell (WBC) count is 5000 to 10,000/mm3. The presence of leukocytosis (WBC count >15,000/μL) indicates that the infection persists despite treatment with an antibiotic. Lung sounds and respiratory rate are not indicators of the efficacy of antibiotic treatment. A low-grade fever also may signify that the infection is persisting; however, the WBC count is the most reliable indicator of active infection.

A patient presents for a follow-up office visit one week after sustaining rib fractures that resulted in flail chest. Which instructions does the nurse provide to the patient? Select all that apply. "You should take a shower instead of a bath for one more week." "You may want to sleep in the semi-Fowler's position to make your breathing easier." "You should apply a binder over your chest during the day while performing activities." "You should wear compression hose throughout the day." "You may experience intercostal pain for several more weeks, so pain medication may still be needed."

You may want to sleep in the semi-Fowler's position to make your breathing easier You may experience intercostal pain for several more weeks, so pain medication may still be needed." The semi-Fowler's position facilitates lung expansion, so the patient will be able to breathe easily. The lung parenchyma and fractured ribs heal with time. Some patients continue to have intercostal pain several weeks after the flail chest has resolved. Bathing will not complicate the patient's condition. Applying a binder will reduce chest expansion, so the nurse does not instruct the patient to apply a binder over his or her chest. There is no indication that compression hose are needed or that the patient is at risk for a thrombosis

A patient with a sudden onset of respiratory distress is scheduled for a ventilation-perfusion scan. Which instruction does the nurse provide to the patient about the procedure? "The test involves the injection of a radioisotope and the inhalation of a radioactive gas." "You will be sedated during the test to prevent you from moving." "It is important to verify that there is no metal in your body before performing the test." "You will feel a sensation of chest pressure as the dye circulates through your body."

"The test involves the injection of a radioisotope and the inhalation of a radioactive gas." A ventilation-perfusion scan has two parts. In the perfusion portion, a radioisotope is injected into the blood, and the pulmonary vasculature is outlined. In the ventilation part, the patient inhales a radioactive gas that outlines the alveoli. Sedation is not required; magnetic imaging is not a component of the examination, so the patient can have the test even if there is metal in the body. Chest pressure may indicate an adverse reaction and is not normal

A patient sustains injuries to the chest as a result of an altercation. The nurse assesses the right lung and notes decreased breath sounds and dullness on percussion. The patient reports difficulty breathing. The nurse makes preparations to assist the health care provider with the insertion of which size chest tube? 12F 24F 28F 38F

38F The symptoms indicate that the patient has a hemothorax, which means blood in the pleural space. Manifestations of a hemothorax include dyspnea, decreased or absent breath sounds, dullness to percussion, decreased hemoglobin, and shock (depending on blood volume lost). The priority intervention is chest tube insertion with a chest drainage system to drain the blood. The size of the tube to be used is determined by the patient's condition. Large tubes (36F to 40F) are used to drain blood; therefore the 38F tube should be used for this patient. Medium (24F to 36F) tubes are used to drain fluid, and small (12F to 24F) tubes are used to drain air.

On the third postoperative day following hip surgery, a patient states, "This morning I started to have shortness of breath, slight chest pain, and a feeling as if something isn't right." The patient's assessment findings include respirations 32 breaths/min, pulse 110 beats/min, and an oxygen saturation of 87% on room air. Which is the priority nursing action? Notify the health care provider (HCP). Apply oxygen. Obtain an electrocardiogram (ECG). Call the rapid response team

Apply oxygen The patient's clinical picture is consistent with pulmonary embolism (PE). The priority is airway, breathing, and circulation. Manifestations of PE depend on the type, size, and extent of emboli. Small emboli may go undetected or cause vague, transient symptoms. Symptoms may begin slowly or appear suddenly. Dyspnea is the most common presenting symptom, occurring in 85% of patients with PE. Mild to moderate hypoxemia may occur. Other manifestations include tachypnea, cough, chest pain, hemoptysis, crackles, wheezing, fever, accentuation of pulmonic heart sound, tachycardia, and syncope. Immediate assessment should focus on the patient's cardiopulmonary status. O2 should be given by mask or cannula when hypoxemia is present. Notifying the HCP, obtaining an ECG, and calling the rapid response team can occur after the patient's respiratory status is addressed.

A patient is hospitalized with a diagnosis of pneumonia. When reviewing the patient's history, the nurse finds that the patient experienced a seizure with profuse vomiting four days prior to the hospital admission. Which type of pneumonia does the nurse suspect? Aspiration pneumonia Opportunistic pneumonia Hospital-associated pneumonia Community-acquired pneumonia

Aspiration pneumonia Aspiration pneumonia results from the abnormal entry of material from the mouth or stomach into the trachea and lungs. Conditions that increase the risk for aspiration include decreased level of consciousness (e.g., seizure, anesthesia, head injury, stroke, alcohol intake), difficulty swallowing, and insertion of nasogastric (NG) tubes with or without enteral feeding. The aspirated material (food, water, vomitus, oropharyngeal secretions) triggers an inflammatory response. The history of the patient does not suggest any exposure to pneumonia in the community. The patient has never been in the hospital; therefore hospital-associated pneumonia is highly unlikely. The patient does not have a history of HIV, intake of immunosuppressive drugs, corticosteroids, or any disorders leading to immunosuppression; therefore opportunistic pneumonia did not occur in this patient

The nurse observes another staff member providing care for a patient who has a chest tube in place. Which action by the staff member may result in increased air in the pleural space and requires the nurse to intervene? Clamps the chest tube while ambulating the patient in the hallway Seals the wound around the chest tube with a petroleum (airtight) gauze Moves the clamp down the tubing while assessing for an air leak Provides instructions related to bearing down when the tube is removed

Clamps the chest tube while ambulating the patient in the hallway Clamping of chest tubes during transport or when the tube is accidentally disconnected is no longer advocated. The danger of rapid accumulation of air in the pleural space, causing tension pneumothorax, is far greater than that of a small amount of atmospheric air that enters the pleural space. Most health care providers prefer to seal the wound around the chest tube with petroleum (airtight) gauze. Moving the clamp down the tubing to assess for an air leak is brief and will not cause an accumulation of air in the pleural space. Bearing down (Valsalva maneuver) during tube removal prevents air from entering the pleural space.

The registered nurse is evaluating the actions of a nursing student who is maintaining a chest drainage unit (CDU) for a patient with chest trauma. The nurse intervenes when the student performs which actions? Select all that apply. Coils the tubing above the chest level Expects air fluctuations in the water-seal chamber Verifies the presence of an air-occlusive dressing over the insertion site Connects the chest tube to wall suction to check for tidaling Positions the tubing so that the drainage flows freely from the insertion site to the collection chamber

Coils the tubing above the chest level Connects the chest tube to wall suction to check for tidaling Coiling of the tubing above the chest level may cause fluid to drain back into the pleural cavity. Therefore the tubing of the drainage system should be coiled below the chest level. The chest tube should be disconnected from wall suction to check the tidaling because the suction will be increased. An absence of air fluctuations in the water-seal chamber indicates blockage of the tubing. The dressing of the drainage system should be air-occlusive to prevent leakage. The tubing should be dropped straight from the bed or chair to the drainage unit for easy flow.

The nurse is caring for a patient with acute pulmonary embolism (PE) and expects that which subcutaneous medication will be included in the patient's treatment plan? Warfarin Alteplase Enoxaparin Tissue plasminogen activator

Enoxaparin Subcutaneous administration of low-molecular-weight heparin (LMWH) (e.g., enoxaparin [Lovenox], fragmin [Dalteparin], or fondaparinux) is the recommended treatment for patients with acute PE. LMWH is safer and more effective than unfractionated heparin. Warfarin (Coumadin) is an oral anticoagulant; it is started at the time of diagnosis. Warfarin should be given for at least three months and then reevaluated. Direct thrombin inhibitors are given IV; some health care providers use them in the treatment of PE. The fibrinolytic agents, such as tissue plasminogen activator (tPA) or alteplase (Activase), may help dissolve the PE and the source of the thrombus in the pelvis or deep leg veins, thereby decreasing the risk for recurrent emboli.

A patient started treatment for sputum smear-positive tuberculosis (TB) 1 week prior to the home health nurse's visit. Which instructions does the nurse provide to the patient to minimize exposure to close contacts and household members? Select all that apply. Increase the intake of foods that are high in vitamin C. Ensure that the home is well ventilated. Sleep alone. Spend as much time as possible outdoors. Minimize time in congregate settings. Minimize time on public transportation

Ensure that the home is well ventilated. Sleep alone. Spend as much time as possible outdoors. Minimize time in congregate settings. Minimize time on public transportation. Patients with sputum smear-positive TB are considered infectious for the first 2 weeks after starting treatment. Homes should be well ventilated, especially the areas where the infected person spends a lot of time. While still infectious, the patient should sleep alone, spend as much time as possible outdoors, and minimize time spent in congregate settings or on public transportation. Increasing the intake of foods that are high in vitamin C does not decrease exposure to others

A pediatric patient presents with a 2-week history of cough, clear sputum, headache, hoarseness, and myalgias. The patient has no significant medical history. The patient's parent asks why there is no plan to administer an antibiotic. How does the nurse respond? Explain that antibiotics are not required for the patient. Advise the parent to see another health care provider for a second opinion. Explain that pertussis is suspected and that bronchodilators are the treatment of choice. Clarify that antibiotics will be prescribed if the cough persists for another week

Explain that antibiotics are not required for the patient The symptoms and signs indicate that the patient may have acute bronchitis, which is a viral disorder. Therefore the nurse should explain to the parent that antibiotics will not help in viral infections. If they are prescribed, antibiotics may cause side effects and may also lead to antibiotic resistance. It is incorrect to advise the parent to see another health care provider, who will likely prescribe a similar course of treatment. The symptoms are not indicative of pertussis. Bronchodilators are not used to treat pertussis. Acute bronchitis is a self-limiting disorder, and the cough may last up to 3 weeks. Informing the parent that antibiotics will be prescribed if the cough persists for another week is not correct.

The nurse determines effective discharge teaching for a patient with pneumonia when the patient makes which statement? "I should seek immediate medical treatment for any upper respiratory infections." "I should continue to do deep-breathing exercises for at least 12 weeks." "I will increase my food intake to 2400 calories a day to keep my immune system well." "I will need to have a follow-up chest x-ray in six to eight weeks to evaluate the pneumonia's resolution."

I will need to have a follow-up chest x-ray in six to eight weeks to evaluate the pneumonia's resolution." The follow-up chest x-ray will be done in six to eight weeks to evaluate pneumonia resolution. A patient should seek medical treatment for upper respiratory infections that persist for more than seven days. It may be important for the patient to continue with deep-breathing exercises for six to eight weeks, not 12 weeks, until all of the infection has cleared from the lungs. Increased fluid intake, not caloric intake, is recommended to liquefy secretions.

The nurse presents education related to pulmonary embolism (PE) to a group of nursing students and includes which risk factors? Select all that apply. Immobility Pregnancy Pelvic surgery within the last three months Herbal therapy Cigarette smoking

Immobility Pregnancy Pelvic surgery within the last three months Cigarette smoking Risk factors for PE include immobility or reduced mobility, surgery within the last three months (especially pelvic and lower extremity surgery), history of venous thromboembolism, cancer, obesity, oral contraceptives, hormone therapy, cigarette smoking, prolonged air travel, heart failure, pregnancy, and clotting disorders. Herbal therapy is not associated with the development of a PE.

How does splinting the incision with a pillow benefit a patient who underwent surgery to repair chest trauma? It reduces pain perception. It facilitates deep breathing. It reduces the risk of an air leak. It increases perfusion at the site

It facilitates deep breathing The patient will have difficulty breathing after surgery as a result of the incision on the chest. Splinting the incision facilitates deep breathing. The nurse administers analgesics to reduce pain. An occlusive dressing is applied over the site of surgery to reduce air leakage. The nurse instructs the patient to perform range-of-motion exercise to increase perfusion or oxygen supply to the injured site

The nurse reviews the process for setting up a wet suction system that is attached to a chest tube and questions which step that is listed in the procedure? Keep the suction control chamber uncovered. Maintain the suction amount at -20 cm H2O pressure. Dial the wall suction regulator to 80 to 120 mm Hg. Dial the wall suction regulator until there is gentle bubbling in the suction control chamber

Keep the suction control chamber uncovered The nurse should keep the cover over the suction control chamber in place to prevent rapid evaporation of water and to decrease the noise of the bubbling. The ordered suction amount is generally at -20 cm H2O pressure. The nurse should dial the wall suction regulator until there is continuous gentle bubbling in the suction control chamber (generally 80 to 120 mm Hg)

A patient experiences a chest injury as a result of a motor vehicle accident. The patient's assessment findings include asymmetric chest excursion and an absence of breath sounds on the left side. Which condition does the nurse suspect? Left-sided pneumothorax Left-sided pleural effusion Pulmonary embolism (PE) Adult respiratory distress syndrome (ARDS)

Left-sided pneumothorax A pneumothorax should be suspected after any trauma to the chest wall. A pneumothorax is caused by air entering the pleural cavity. The pleural space has a few milliliters of lubricating fluid to reduce friction when the tissues move. When air enters this space, the change in positive pressure causes a partial or complete lung collapse. As the volume of air in the pleural space increases, lung volume decreases. The patient described experienced a closed (no external wound) pneumothorax. When the left part of a chest is crushed, breathing will be compromised, resulting in asymmetric excursion. On auscultation, breath sounds are absent over the affected area. PE is an abnormal collection of fluid in the pleural space. Clinical manifestations associated with PE include dyspnea, hypoxemia, tachypnea, cough, chest pain, hemoptysis, crackles, wheezing, fever, accentuation of pulmonic heart sound, tachycardia, and syncope. There is not enough information to conclude that ARDS has developed. The risk for ARDS is greater after the initial injury, not at the time of the injury.

The nurse cares for a patient who is immunocompetent and presents with pulmonary tuberculosis (TB). Which clinical manifestation does the nurse expect? Mucopurulent sputum Diarrhea Lymph node enlargement Dehydration

Mucopurulent sputum A cough that progresses in frequency and produces mucoid or mucopurulent sputum is the most common symptom of pulmonary TB. Diarrhea, lymph node enlargement, and dehydration are manifestations not directly associated with pulmonary TB in a patient who is immunocompetent

The nurse finds that a patient with chest trauma exhibits cyanosis, air hunger, neck vein distention, and an increase in intrathoracic pressure. The nurse prepares for which procedure? Pericardiocentesis Needle decompression Insertion of a chest tube with a flutter valve Insertion of a chest tube with a drainage system

Needle decompression Cyanosis, air hunger, extreme agitation, subcutaneous emphysema, neck vein distention, hyperresonance to percussion, and tracheal deviation away from affected side (late sign) are manifestations of a tension pneumothorax in a patient with chest trauma. A tension pneumothorax is a complication associated with the presence of excess air in the pleural thorax that cannot escape and is treated with needle decompression. Pericardiocentesis is helpful in aspirating fluid from the pleural space, which is more useful in cases of cardiac tamponade. Insertion of a chest tube with a flutter valve or a chest tube with drainage are techniques that help to drain air from the lung. However, these techniques are performed after needle decompression

An unconscious patient who was brought to the emergency department responded well to cardiopulmonary resuscitation (CPR). After several hours in stable condition, the patient experiences dyspnea, tachycardia, cyanosis, and neck vein distention. The nurse prepares for which immediate intervention? Pericardiocentesis Insertion of a central venous access device (CVAD) Needle decompression Placing the patient in the Trendelenburg position

Needle decompression The symptoms and signs indicate that the patient has a tension pneumothorax. Tension pneumothorax occurs when air enters the pleural space but cannot escape. The continued accumulation of air in the pleural space causes increasingly elevated intrapleural pressures. This results in compression of the lung on the affected side and pressure on the heart and great vessels, pushing them away from the affected side. If the tension in the pleural space is not relieved, the patient is likely to die from inadequate cardiac output or severe hypoxemia. Therefore the patient requires immediate needle decompression followed by chest tube insertion with a chest drainage system. Pericardiocentesis is the treatment for cardiac tamponade. Insertion of a CVAD is not the priority. The patient will likely be placed in the semi-Fowler's position to facilitate breathing.

The nurse reviews the medical record of a patient with a pneumothorax and notes that the patient has a minimal amount of fluid accumulated in the intrapleural space and that the patient is stable. Which does the nurse infer? No treatment may be needed. The patient will require treatment with chest tube drainage. Treatment will include aspiration using a large-bore needle. The primary treatment plan will be needle decompression

No treatment may be needed Treatment of a pneumothorax depends on its severity, its underlying cause, and the hemodynamic stability of the patient. If the patient is stable and has minimal air and/or fluid accumulated in the intrapleural space, no treatment may be needed because the condition may resolve spontaneously. Chest tube drainage is helpful to drain the fluid; however, this procedure is performed when the patient has severe complications. Aspiration with a large-bore needle is thoracentesis. This procedure is performed when the patient has fluid accumulation in the complete lung. Needle decompression helps to resolve pneumothorax when the patient has a medical emergency.

The health care provider prescribes IV vancomycin for a patient with pneumonia. Which action does the nurse perform first? Obtain a full set of vital signs. Obtain sputum cultures for sensitivity. Educate the patient about the adverse effects associated with the medication. Draw a blood specimen to evaluate the white blood cell count

Obtain sputum cultures for sensitivity The nurse should ensure that the sputum for culture and sensitivity has been sent to the laboratory before administering the antibiotic. It is important that the organisms be correctly identified (in the culture) before their numbers are affected by the antibiotic; the test also will determine whether the proper antibiotic has been prescribed (sensitivity testing). Vital signs, education, and white blood cell count measurement can be assessed following the obtainment of sputum cultures

When a patient is diagnosed with a lung abscess, which does the nurse teach the patient? Lobectomy surgery usually is needed to drain the abscess. IV antibiotic therapy will be used for a prolonged period of time. Oral antibiotics will be used when the patient and x-ray show evidence of improvement. No further culture and sensitivity tests are needed if the patient takes the medication as prescribed

Oral antibiotics will be used when the patient and x-ray show evidence of improvement IV antibiotics are used until the patient and x-ray show evidence of improvement. Then oral antibiotics are used for a prolonged period of time. Lobectomy surgery is needed only when reinfection of a large cavitary lesion occurs or to establish a diagnosis when there is evidence of a neoplasm or other underlying problem. Culture and sensitivity testing is done during the course of antibiotic therapy to ensure that the infecting organism is not becoming resistant to the antibiotic, as well as at the completion of the antibiotic therapy

When a patient is diagnosed with a lung abscess, which does the nurse teach the patient? Lobectomy surgery usually is needed to drain the abscess. IV antibiotic therapy will be used for a prolonged period of time. Oral antibiotics will be used when the patient and x-ray show evidence of improvement. No further culture and sensitivity tests are needed if the patient takes the medication as prescribed.

Oral antibiotics will be used when the patient and x-ray show evidence of improvement IV antibiotics are used until the patient and x-ray show evidence of improvement. Then oral antibiotics are used for a prolonged period of time. Lobectomy surgery is needed only when reinfection of a large cavitary lesion occurs or to establish a diagnosis when there is evidence of a neoplasm or other underlying problem. Culture and sensitivity testing is done during the course of antibiotic therapy to ensure that the infecting organism is not becoming resistant to the antibiotic, as well as at the completion of the antibiotic therapy

The nurse reviews the medical records of six adults and determines that the pneumococcal polysaccharide vaccine will be recommended for which patients? Select all that apply. Patient A: age 25; obesity Patient B: age 35; smokes cigarettes Patient C: age 45; diabetes Patient D: age 55; had spleen removed as a teenager Patient E: age 65; elevated cholesterol level Patient F: age 75; no significant medical history

Patient B: age 35; smokes cigarettes Patient C: age 45; diabetes Patient D: age 55; had spleen removed as a teenager Patient E: age 65; elevated cholesterol level Patient F: age 75; no significant medical history The pneumococcal polysaccharide vaccine is used to prevent pneumococcal pneumonia. The vaccine is recommended for adults aged 19 to 64 who smoke cigarettes; therefore it would be recommended for Patient B. It is also recommended for anyone aged 2 to 64 with certain long-term health problems (e.g., diabetes); therefore it would be recommended for Patient C. It is also recommended for patients with a disease or condition that weakens the immune system (e.g., damaged or no spleen); therefore it would be recommended for Patient D. It is also recommended for all adults aged 65 or more; therefore it would be recommended for Patients E and F. Obesity is not a condition for which the vaccine is recommended; therefore it would not be recommended for Patient A

A patient with chest trauma has a chest tube on gravity drainage. While assessing the patient, the nurse finds that the fluid level in the water-seal chamber is very high. Which action does the nurse take? Apply a clamp to the tube. Retape the tube connections. Lower the water-seal column. Release the high-negativity valve

Release the high-negativity valve. High fluid levels in the water seal indicate residual negative pressure. The chest system may have to be vented by using the high-negativity release valve available on the drainage system to release residual pressure from the system. Applying a clamp will stop the suction and decrease the risk of leakage but will not reduce negative pressure. Retaping the tube connections reduces leakage from the tube. The patient is on gravity drainage; therefore lowering the water-seal column may cause complications for the patient.

The nurse provides teaching for a patient who is scheduled for a bedside thoracentesis. Which does the nurse explain as the primary purpose of the procedure? Determining the stage of a lung tumor Directly inspecting and examining the pleural space Obtaining a specimen of pleural tissue for evaluation Relieving an abnormal accumulation of fluid in the pleural space

Relieving an abnormal accumulation of fluid in the pleural space Thoracentesis involves the insertion of a large-bore needle into the pleural space to relieve an abnormal accumulation of fluid in the pleural space. The procedure can significantly relieve symptoms related to this fluid accumulation, such as shortness of breath and discomfort. Thoracentesis cannot reveal the stage of lung cancer or permit direct inspection and examination of the pleural space. It may provide a pleural fluid specimen but not a pleural tissue specimen

The nurse identifies a nursing diagnosis of impaired gas exchange for a patient with pneumonia based on which physical assessment findings? Select all that apply. SpO2 of 85% PaCO2 of 65 mm Hg Thick yellow mucus expectorant Respiratory rate of 24 breaths/minute Dullness to percussion over the affected area

SpO2 of 85% PaCO2 of 65 mm Hg Dullness to percussion over the affected area Indications of impaired gas exchange for this patient include a decreased oxygen saturation level (SpO2 less than 90%) and an increased partial pressure of carbon dioxide level (PaCO2 greater than 45 mm Hg). PaCO2 is the partial pressure of carbon dioxide in arterial blood. Dullness to percussion over the affected area indicates a pleural effusion, which is associated with pneumonia. Yellow mucus would indicate clearance of secretions. An increased respiratory rate does not imply impaired gas exchange.

The bubbling in a patient's chest drainage unit (CDU) has increased, and the nurse suspects an air leak. The patient's chest tube is numbered from 1 to 5 in regular increments on the tube. To determine the location of the air leak, the nurse briefly and methodically clamps down the tubing away from the patient. The leak stops when the tube is clamped between the numbers 3 and 4. How does the nurse interpret the finding? The air leak is in the patient's chest. The air leak is in the tube between points 1 and 2. The air leak is in the tube between points 3 and 4. The air leak is in the collection chamber of the CDU

The air leak is in the tube between points 3 and 4. Whenever the bubbling increases, the nurse should suspect an air leak. If a leak persists, the nurse should briefly clamp the chest tube starting at the patient's chest. The nurse should briefly and methodically move the clamps down the tubing, away from the patient, until the air leak stops. The leak will then be present between the last two clamp points. If the leak persists, the nurse should briefly clamp the chest tube at the patient's chest. If the leak stops when the tube is clamped at the patient's chest, the air is coming from the patient. For this patient, the leak is present between the last two clamp points, which are numbers 3 and 4. If the air leak persists all the way to the drainage unit, the unit should be replaced.

Following a thoracotomy, a patient uses patient-controlled analgesia (PCA). Which related outcomes does the nurse expect? Select all that apply. The patient will have an effective cough. The patient will be able to take deep breaths. The patient will have reexpansion of the lungs. The patient will have reduced pulmonary edema. The patient will be able to move the arm on the operative side

The patient will have an effective cough The patient will be able to take deep breaths The patient will be able to move the arm on the operative side. Thoracotomy is a painful procedure and involves cutting respiratory muscles during the surgery. Postoperative use of PCA, epidural infusions, and intercostal nerve blocks allows patients to breathe deeply, cough, and move the arm and shoulder on the operative side. The chest tube placed on the chest after thoracotomy helps lung expansion. The nurse administers diuretics to relieve pulmonary edema.

The nurse reviews the medical records of patients diagnosed with community-acquired pneumonia (CAP) and identifies that the patients meet which criterion? The patients presented to the hospital with symptoms of pneumonia. The patients were in close proximity with someone who had pneumonia within the past 10 days of the onset of symptoms. The patients have not been hospitalized or have not lived in a long-term care facility within 14 days of the onset of symptoms. The patients have a condition that weakens the immune system.

The patients have not been hospitalized or have not lived in a long-term care facility within 14 days of the onset of symptoms CAP is an acute infection of the lung occurring in patients who have not been hospitalized or lived in a long-term care facility within 14 days of the onset of symptoms

The nurse provides information to a group of nursing students about wounds that result from penetrating trauma to the chest wall and includes which example? Wound caused by a gunshot Wound caused by a crush injury When the chest is struck by a baseball When the chest strikes a steering wheel

Wound caused by a gunshot The wound caused by a gunshot is a penetrating trauma because it is an open injury in which a foreign object enters into the body. A crush injury, when the chest is struck by an object, and when the chest strikes an object are examples of blunt trauma.