Med Surg 1 Final #2

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130. A client with acute respiratory distress syndrome (ARDS) is on a ventilator. The client's peak inspiratory pressures and spontaneous respiratory rate are increasing, and the PO2 is not improving. Using the SBAR (Situation-Background-Assessment- Recommendation) technique for communication, the nurse calls the physician with the recommenda- tion for: 1. Initiating I.V. sedation. 2. Starting a high-protein diet. 3. Providing pain medication. 4. Increasing the ventilator rate.

48. Which of the following symptoms is common in clients with active tuberculosis? 1. Weight loss. 2. Increased appetite. 3. Dyspnea on exertion. 4. Mental status changes.

70. Which of the following physical assessment findings are normal for a client with advanced chronic obstructive pulmonary disease (COPD)? 1. Increased anteroposterior chest diameter. 2. Underdeveloped neck muscles. 3. Collapsed neck veins. 4. Increased chest excursions with respiration.

73. Which of the following is a priority goal for the client with chronic obstructive pulmonary dis- ease (COPD)? 1. Maintaining functional ability. 2. Minimizing chest pain. 3. Increasing carbon dioxide levels in the blood. 4. Treating infectious agents.

92. Which of the following health promotion activities should the nurse include in the discharge teaching plan for a client with asthma? 1. Incorporate physical exercise as tolerated into the daily routine. 2. Monitor peak flow numbers after meals and at bedtime. 3. Eliminate stressors in the work and home environment. 4 Use sedatives to ensure uninterrupted sleep at night.

95. The nurse has assisted the physician at the bedside with insertion of a left subclavian, triple lumen catheter in a client admitted with lung cancer. Suddenly, the client becomes restless and tachypneic. The nurse should: 1. Assess breath sounds. 2. Remove the catheter. 3. Insert a peripheral I.V. 4. Reposition the client.

99. Which of the following areas is a priority to evaluate when completing discharge planning for a client who has had a lobectomy for treatment of lung cancer? 1. The support available to assist the client at home. 2. The distance the client lives from the hospital. 3. The client's ability to do home blood pressure monitoring. 4. The client's knowledge of the causes of lung cancer.

A client experiencing a severe asthma attack has the following arterial blood gas:pH 7.33; PCO2 48; PO2 58; HCO3 26. Which of the fol- lowing orders should the nurse perform first? 1. Albuterol (Proventil) nebulizer. 2. Chest x-ray. 3. Ipratropium (Atrovent) inhaler. 4. Sputum culture.

A client has a chest tube attached to a water- seal drainage system and the nurse notes that the fluid in the chest tube and in the water-seal column has stopped fluctuating. The nurse should deter- mine that: ■ 1. The lung has fully expanded. ■ 2. The lung has collapsed. 3. The chest tube is in the pleural space. ■ 4. The mediastinal space has decreased.

A client has been in an automobile accident and the nurse is assessing the client for possible pneumothorax. The nurse should assess the client for: 1. Sudden, sharp chest pain. 2. Wheezing breath sounds over affected side. 3. Hemoptysis. 4. Cyanosis.

A client informs the nurse that she is using an herbal therapy while receiving chemotherapy. Which of the following actions should the nurse take? 1. Determine what substances the client is using and make sure that the physician is aware of all therapies the client is using. 2. Guide the client in the decision-making process to select either Western or alternative medicine. 3. Encourage the client to seek alternative modalities that do not require the ingestion of substances. 4. Recommend that the client stop using the alternative medicines immediately.

A client is being discharged with nasal pack- ing in place. The nurse should instruct the client to: 1. Perform frequent mouth care. 2. Use normal saline nose drops daily. 3. Sneeze and cough with mouth closed. 4. Gargle every 4 hours with salt water.

A client is prescribed metaproterenol (Alu- pent) via a metered-dose inhaler, two puffs every4 hours. The nurse instructs the client to report adverse effects. Which of the following are potential adverse effects of metaproterenol? ■ 1. Irregular heartbeat. ■ 2. Constipation. ■ 3. Pedal edema. ■ 4. Decreased pulse rate.

A client who has undergone outpatient nasal surgery is ready for discharge and has nasal packing in place. Which of the following discharge instruc- tions would be appropriate for the client? 1. Avoid activities that elicit the Valsalva maneuver. 2. Take aspirin to control nasal discomfort. 3. Avoid brushing the teeth until the nasal packing is removed. 4. Apply heat to the nasal area to control swelling.

A client who is human immunodeficiency virus (HIV)-positive has had a tuberculin skin test (TST). The nurse notes a 7-mm area of induration at the site of the skin test and interprets the result as which finding? 1. Positive 2. Negative 3. Inconclusive 4. Need for repeat testing

A client who underwent a lobectomy and has a water-seal chest drainage system is breathing with a little more effort and at a faster rate than 1 hour ago. The client's pulse rate is also increased. The nurse should: 1. Check the tubing to ensure that the client is not lying on it or kinking it. 2. Increase the suction. 3. Lower the drainage bottles 2 to 3 feet below the level of the client's chest. 4. Ensure that the chest tube has two clamps on it to prevent air leaks.

A client with acquired immunodeficiency syndrome (AIDS) has histoplasmosis. The nurse should assess the client for which expected finding? 1. Dyspnea 2. Headache 3. Weight gain 4. Hypothermia

A client with deep vein thrombosis suddenly develops dyspnea, tachypnea, and chest discomfort. What should the nurse do first? ■ 1. Elevate the head of the bed 30 to 45 degrees. ■ 2. Encourage the client to cough and deep breathe. ■ 3. Auscultate the lungs to detect abnormal breath sounds. ■ 4. Contact the physician.

A female client diagnosed with lung can- cer is to have a left lower lobectomy. Which of the following increase the client's risk of developing postoperative pulmonary complications? 1. Height is 5 feet, 7 inches and weight is 110 lb. 2. The client tends to keep her real feelings to herself. 3. She ambulates and can climb one flight of stairs without dyspnea. 4. The client is 58 years of age.

A nurse is caring for a client 24 hours after he has undergone an abdominal-perineal resection for a bowel tumor. The client's wife asks if she can bring him some of his favorite home-cooked Italian minestrone soup. What would be an appropriate action by the nurse? 1. Auscultate for bowel sounds. 2. Ask the client if he feels hunger or gas pains. 3. Consult the dietician. 4. Encourage the wife to bring the soup.

For a client with rib fractures and a pneu- mothorax, the physician prescribes morphine sulfate, 1 to 2 mg/hour, given I.V. as needed for pain. The nursing care goal is to provide adequate pain control so that the client can breathe effectively. Which of the following outcomes would indicate successful achievement of this goal? 1. Pain rating of 0 on a scale of 0 to 10 by the client. 2. Decreased client anxiety. 3. Respiratory rate of 26 breaths/minute. 4. PaO2 of 70 mm Hg.

The HCP has recommended a total laryngectomy for a male client diagnosed with cancer of the larynx but the client refuses. Which intervention by the nurse illustrates the ethical principle of nonmalfeasance? 1. The nurse listens to the client explain why he is refusing surgery. 2. The nurse and significant other insist that the client have the surgery. 3. The nurse refers the client to a counselor for help with the decision. 4. The nurse asks a cancer survivor to come and discuss the surgery with the client.

The charge nurse is assigning clients for the shift. Which client should be assigned to the new graduate nurse? 1. The client diagnosed with cancer of the lung who has chest tubes. 2. The client diagnosed with laryngeal spasms who has stridor. 3. The client diagnosed with laryngeal cancer who has multiple fistulas. 4. The client who is two (2) hours post-partial laryngectomy.

The client diagnosed with a pulmonary embolus is being discharged. Which intervention should the nurse discuss with the client? 1. Increase fluid intake to two (2) to three (3) L/day. 2. Eat a low-cholesterol, low-fat diet. 3. Avoid being around large crowds. 4. Receive pneumonia and flu vaccines.

The client diagnosed with an exacerbation of COPD is in respiratory distress. Which intervention should the nurse implement first? 1. Assist the client into a sitting position at 90 degrees. 2. Administer oxygen at six (6) LPM via nasal cannula. 3. Monitor vital signs with the client sitting upright. 4. Notify the health-care provider about the client's status.

The client is admitted to a medical unit witha diagnosis of pneumonia. Which signs and symptoms should the nurse assess in the client? 1. Pleuritic chest discomfort and anxiety. 2. Asymmetrical chest expansion and pallor. 3. Leukopenia and CRT <three (3) seconds. 4. Substernal chest pain and diaphoresis.

The client is suspected of having a pulmonary embolus. Which diagnostic test suggests the presence of a pulmonary embolus and requires further investigation? 1. Plasma D-dimer test. 2. Arterial blood gases. 3. Chest x-ray (CXR). 4. Magnetic resonance imaging (MRI).

The influenza vaccine is in short supply. Which group of clients would the public health nurse consider priority when administering the vaccine? 1. Elderly and chronically ill clients. 2. Child-care workers and children less than four (4) years of age. 3. Hospital chaplains and health-care workers. 4. Schoolteachers and students living in a dormitory.

The nurse observes the unlicensed assistive personnel (UAP) entering an airborne isolation room and leaving the door open. Which action is the nurse's best response? 1. Close the door and discuss the UAP's action after coming out of the room. 2. Make the UAP come back outside the room and then reenter, closing the door. 3. Say nothing to the UAP but report the incident to the nursing supervisor. 4. Enter the client's room and discuss the matter with the UAP immediately.

When developing a discharge plan to manage the care of a client with chronic obstructive pulmo- nary disease (COPD), the nurse should advise the the client to expect to: 1. Develop respiratory infections easily. 2. Maintain current status. 3. Require less supplemental oxygen. 4. Show permanent improvement.

When suctioning a tracheostomy or larynge- ctomy tube, the nurse should follow which of the following procedures? 1. Use a sterile catheter each time the client is suctioned. 2. Clean the catheter in sterile water after each use and reuse for no longer than 8 hours. 3. Protect the catheter in sterile packaging between suctioning episodes. 4. Use a clean catheter with each suctioning, and disinfect it in hydrogen peroxide between uses.

Which action should the nurse implement for the client with a hemothorax who has a right- sided chest tube with excessive bubbling in the water-seal compartment? 1. Check the amount of wall suction being applied. 2. Assess the tubing for any blood clots. 3. Milk the tubing proximal to distal. 4. Encourage the client to cough forcefully.

1. Rural farming areas. 2. Inner-city areas. 3. Areas where clean water standards are low. 4. Suburban areas with significant industrial pollution.

A client undergoes surgery to repair lung inju- ries. Postoperative orders include the transfusion of one unit of packed red blood cells at a rate of 60 mL/ hour. How long would this transfusion take to infuse? 1. 2 hours. 2. 4 hours. 3. 6 hours. 4. 8 hours.

The client is admitted to the emergency department with chest trauma. Which signs/ symptoms indicate to the nurse the diagnosis of pneumothorax? 1. Bronchovesicular lung sounds and bradypnea. 2. Unequal lung expansion and dyspnea. 3. Frothy, bloody sputum and consolidation. 4. Barrel chest and polycythemia.

111. Which of the following should be readily available at the bedside of a client with a chest tube in place? 1. A tracheostomy tray. 2. Another sterile chest tube. 3. A bottle of sterile water. 4. A spirometer.

44.Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia? ■ 1. Coma. ■ 2. Apathy. ■ 3. Irritability. ■ 4. Depression.

61. Clients who have had active tuberculosis are at risk for recurrence. Which of the following condi- tions increases that risk? 1. Cool and damp weather. 2. Active exercise and exertion. 3. Physical and emotional stress. 4. Rest and inactivity.

69 Which of the following indicates that the client with chronic obstructive pulmonary disease (COPD) who has been discharged to home under- stands his care plan? 1. The client promises to do pursed-lip breath ing at home. 2. The client states actions to reduce pain. 3. The client says that he will use oxygen via a nasal cannula at 5 L/minute. 4. The client agrees to call the physician if dyspnea on exertion increases.

80. Which of the following diets would be most appropriate for a client with chronic obstructive pulmonary disease (COPD)? 1. Low-fat, low-cholesterol diet. 2. Bland, soft diet. 3. Low-sodium diet. 4. High-calorie, high-protein diet.

A client is beginning external beam radia- tion therapy to the right axilla after a lumpectomy for breast cancer. Which of the following should the nurse include in client teaching? 1. Use a heating pad under the right arm. 2. Immobilize the right arm. 3. Place ice on the area after each treatment. 4. Apply deodorant only under the left arm.

A nurse is checking the laboratory results of a 52-year-old client with colon cancer admitted for fur- ther chemotherapy. The client has lost 30 lb (13.6 kg) since initiation of the treatment. Which laboratory result should be reported to the health care provider? ■ 1. Blood glucose level of 95 mg/dL. ■ 2. Total cholesterol level of 182 mg/dL. ■ 3. Hemoglobin level of 12.3 mg/dL. ■ 4. Albumin level of 2.8 g/dL.

A terminally ill 82-year-old client in hospice care is experiencing nausea and vomiting because of a partial bowel obstruction. To respect the client's wishes for conservative management of the nausea and vomiting, the nurse should recommend theuse of: 1. A nasogastric (NG) suction tube. 2. I.V. antiemetics. 3. Osmotic laxatives. 4. A clear liquid diet

The nurse is assessing a client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse should assess for which earliest sign of acute respiratory distress syndrome? 1. Bilateral wheezing 2. Inspiratory crackles 3. Intercostal retractions 4. Increased respiratory rate

The nurse should include which of the following instructions when developing a teaching plan for a client who is receiving isoniazidand rifampin (Rifamate) for treatment of tuberculosis? 1. Take the medication with antacids. 2. Double the dosage if a drug dose is missed. 3. Increase intake of dairy products. 4. Limit alcohol intake.

1. A nurse is completing the health history for a client who has been taking echinacea for a head cold. The client asks, "Why isn't this helping me feel better?" Which of the following responses by the nurse would be the most accurate? 1. "There is limited information as to the effectiveness of herbal products." 2. "Antibiotics are the agents needed to treat a head cold." 3. "The head cold should be gone within the month." 4. "Combining herbal products with prescription antiviral medications is sure to help you."

104. When teaching a client to deep breathe effectively after a lobectomy, the nurse should instruct the client to do which of the following? 1. Contract the abdominal muscles, take a slow deep breath through the nose and hold it for 3 to 5 seconds, then exhale. 2. Contract the abdominal muscles, take a deep breath through the mouth, and exhale slowly as if trying to blow out a candle. 3. Relax the abdominal muscles, take a slow deep breath through the nose, and hold it for 3 to 5 seconds. 4. Relax the abdominal muscles, take a deep breath through the mouth, and exhale slowly over 10 seconds.

50. A client is receiving streptomycin for the treatment of tuberculosis. The nurse should assess the client for eighth cranial nerve damage by observ- ing the client for: 1. Vertigo. 2. Facial paralysis. 3. Impaired vision. 4. Difficulty swallowing.

55. Which of the following techniques for admin- istering the Mantoux test is correct? ■ 1. Hold the needle and syringe almost parallel to the client's skin. ■ 2. Pinch the skin when inserting the needle. ■ 3. Aspirate before injecting the medication. ■ 4. Massage the site after injecting the medica- tion.

A 58-year-old male is going to have chemo- therapy for lung cancer. He asks the nurse how the chemotherapeutic drugs will work. The most accu- rate explanation the nurse can give is which of the following? 1. "Chemotherapy affects all rapidly dividing cells." 2. "The molecular structure of the DNA is altered." 3. "Cancer cells are susceptible to drug toxins." 4. "Chemotherapy encourages cancer cells to divide."

A 79-year-old female client is admitted to the hospital with a diagnosis of bacterial pneumonia. While obtaining the client's health history, the nurse learns that the client has osteoarthritis, follows a vegetarian diet, and is very concerned with cleanli- ness. Which of the following would most likely be a predisposing factor for the diagnosis of pneumonia? ■ 1. Age. ■ 2. Osteoarthritis. ■ 3. Vegetarian diet. ■ 4. Daily bathing.

A client has just returned from the postan- esthesia care unit after undergoing a laryngectomy. Which of the following interventions should the nurse include in the plan of care? 1. Maintain the head of the bed at 30 to 40 degrees. 2. Teach the client how to use esophageal speech. 3. Initiate small feedings of soft foods. 4. Irrigate drainage tubes as needed.

A client has the following arterial blood gas values: pH, 7.52; PaO2, 50 mm Hg; PaCO2, 28 mm Hg; HCO -, 24 mEq/L. Based upon the client's PaO , 32 which of the following conclusions would be accu- rate? 1. The client is severely hypoxic. 2. The oxygen level is low but poses no risk for the client. 3. The client's PaO2 level is within normal range. 4. The client requires oxygen therapy with very low oxygen concentrations.

Which information should the nurse teach the client diagnosed with acute sinusitis?1. 1. Instruct the client to complete all the ordered antibiotics. 2. Teach the client how to irrigate the nasal passages. 3. Have the client demonstrate how to blow the nose. 4. Give the client samples of a narcotic analgesic for the headache.

Bed rest is prescribed for a client with pneu- monia during the acute phase of the illness. The nurse should determine the effectiveness of bed rest by assessing the client's: 1. Decreased cellular demand for oxygen. 2. Reduced episodes of coughing. 3. Diminished pain when breathing deeply. 4. Ability to expectorate secretions more easily.

The charge nurse is making rounds. Which client should the nurse assess first? 1. The 29-year-old client diagnosed with reactive airway disease who is complaining the nurse caring for him was rude. 2. The 76-year-old client diagnosed with heart failure who has 2+ edema of the lower extremities. 3. The 15-year-old client diagnosed with diabetic ketoacidosis after a bout with the flu who has a blood glucose reading of 189 mg/dL. 4. The 62-year-old client diagnosed with COPD and pneumonia who is receiving O2 by nasal cannula at two (2) liters per minute.

The client diagnosed with ARDS is on a ventilator and the high alarm indicates an increase in the peak airway pressure. Which intervention should the nurse implement first? 1. Check the tubing for any kinks. 2. Suction the airway for secretions. 3. Assess the lip line of the ET tube. 4. Sedate the client with a muscle relaxant.

The client diagnosed with lung cancer has been told the cancer has metastasized to the brain. Which intervention should the nurse implement? 1. Discuss implementing an advance directive. 2. Explain the use of chemotherapy for brain involvement. 3. Teach the client to discontinue driving. 4. Have the significant other make decisions for the client.

The client diagnosed with lung cancer is being discharged. Which statement made by the client indicates more teaching is required? 1. "It doesn't matter if I smoke now. I already have cancer." 2. "I should see the oncologist at my scheduled appointment." 3. "If I begin to run a fever, I should notify the HCP." 4. "I should plan for periods of rest throughout the day."

The client is diagnosed with cancer of the larynx and is to have radiation therapy to the area. Which prophylactic procedure will the nurse prepare the client for? 1. Removal of the client's teeth and fitting for dentures. 2. Take antiemetic medications every four (4) hours. 3. Wear sunscreen on the area at all times. 4. Placement of a nasogastric feeding tube

The health-care provider ordered STAT arterial blood gases (ABGs) for the client diagnosed with ARDS. The ABG results are pH 7.38, Pao2 92, Paco2 38, Hco3 24. Which action should the nurse implement? 1. Continue to monitor the client without taking any action. 2. Encourage the client to take deep breaths and cough. 3. Administer one (1) ampule of sodium bicarbonate IVP. 4. Notify the respiratory therapist of the ABG results.

Which instruction is priority for the nurse to discuss with the client diagnosed with ARDS who is being discharged from the hospital? 1. Avoid smoking and exposure to smoke. 2. Do not receive flu or pneumonia vaccines. 3. Avoid any type of alcohol intake. 4. It will take about one (1) month to recuperate.

The nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients on a surgical floor. Which information provided by the UAP requires immediate intervention by the nurse? 1. There is a small, continuous amount of bright-red drainage coming out from under the dressing of the client who had a radical neck dissection. 2. The client who has had a right upper lobectomy is complaining that the patient- controlled analgesia (PCA) pump is not providing any relief. 3. The client diagnosed with cancer of the lung is complaining of being tired and short of breath. 4. The client admitted with chronic obstructive pulmonary disease is making a whistling sound with every breath.

The nurse in the perioperative area is preparing a client for surgery and notices that the client looks sad. The client says, "I'm scared of hav- ing cancer. It's so horrible and I brought it on myself. I should have quit smoking years ago." What would be the nurse's best response to the client? ■ 1. "It's okay to be scared. What is it about cancer that you're afraid of?" ■ 2. "It's normal to be scared. I would be, too. We'll help you through it." ■ 3. "Don't be so hard on yourself. You don't know if your smoking caused the cancer." ■ 4. "Do you feel guilty because you smoked?"

The nurse is assessing a 79-year-old client diagnosed with pneumonia. Which signs and symptoms should the nurse expect to assess in the client? 1. Confusion and lethargy. 2. High fever and chills. 3. Frothy sputum and edema. 4. Bradypnea and jugular vein distention.

The nurse is caring for a client diagnosed with a cold. Which is an example of an alternative therapy? 1. Vitamin C, 2,000 mg daily. 2. Strict bedrest. 3. Humidification of the air. 4. Decongestant therapy.

The nurse is discharging a client newly diagnosed with restrictive airway disease (asthma). Which statement indicates the client understands the discharge instructions? 1. "I will call 911 if my medications don't control an attack." 2. "I should wash my bedding in warm water." 3. "I can still eat at the Chinese restaurant when I want." 4. "If I get a headache, I should take a nonsteroidal anti-inflammatory drug."

The nurse is planning the care of a client diagnosed with asthma and has writtena problem of "anxiety." Which nursing intervention should be implemented? 1. Remain with the client. 2. Notify the health-care provider. 3. Administer an anxiolytic medication. 4. Encourage the client to drink fluids.

The nurse is planning to teach a client with chronic obstructive pulmonary disease how to cough effectively. Which of the following instruc- tions should be included? 1. Take a deep abdominal breath, bend forward, and cough three or four times on exhalation. 2. Lie flat on the back, splint the thorax, take two deep breaths, and cough. 3. Take several rapid, shallow breaths and then cough forcefully. 54. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing.

The nurse is providing follow-up care to a client with tuberculosis who does not regularly take his medication. Which nursing action would be most appropriate for this client? 1. Ask the client's spouse to supervise the daily administration of the medications. 2. Visit the client weekly to ask him whether he is taking his medications regularly. 3. Notify the physician of the client's noncompliance and request a different prescription. 4. Remind the client that tuberculosis can be fatal if it is not treated promptly.

The nurse is taking the history of a client with occupational lung disease (silicosis). The nurse should assess whether the client wears which item during periods of exposure to silica particles? 1. Mask 2. Gown 3. Gloves 4. Eye protection

The nurse is teaching a 17-year-old client and the client's family about what to expect with high- dose chemotherapy and the effects of neutropenia. What should the nurse teach as the most reliable early indicator of infection in a neutropenic client? ■ 1. Fever. ■ 2. Chills. ■ 3. Tachycardia. ■ 4. Dyspnea.

The nurse suspects the client may be developing ARDS. Which assessment data confirm the diagnosis of ARDS? 1. Low arterial oxygen when administering high concentration of oxygen. 2. The client has dyspnea and tachycardia and is feeling anxious. 3. Bilateral breath sounds clear and pulse oximeter reading is 95%. 4. The client has jugular vein distention and frothy sputum.

The unlicensed assistive personnel (UAP)is bathing the client diagnosed with acute respiratory distress syndrome (ARDS). The bed is in a high position with the opposite side rail in the low position. Which action should the nurse implement? 1. Demonstrate the correct technique for giving a bed bath. 2. Encourage the UAP to put the bed in the lowest position. 3. Instruct the UAP to get another person to help with the bath. 4. Provide praise for performing the bath safely for the client and the UAP.

Which intervention should the nurse implement first for the client diagnosed with a hemothorax who has had a right-sided chest tube for three (3) days and has no fluctuation (tidaling) in the water compartment? 1. Assess the client's bilateral lung sounds. 2. Obtain an order for a STAT chest x-ray. 3. Notify the health-care provider as soon as possible. 4. Document the findings in the client's chart.

Which intervention should the nurse implement for a male client who has had a left-sided chest tube for six (6) hours and who refuses to take deep breaths because of the pain? 1. Medicate the client and have the client take deep breaths. 2. Encourage the client to take shallow breaths to help with the pain. 3. Explain deep breaths do not have to be taken at this time. 4. Tell the client if he doesn't take deep breaths, he could die.

Which of the following are expected out- comes for a client with pulmonary disease? 1. A relatively matched ventilation-to-perfusion ratio. 2. A low ventilation-to-perfusion ratio. 3. A high ventilation-to-perfusion ratio. 4. An equal PaO and PaCO ratio. 22

Which of the following complications is asso- ciated with mechanical ventilation? ■ 1. Gastrointestinal hemorrhage. ■ 2. Immunosuppression. ■ 3. Increased cardiac output. ■ 4. Pulmonary emboli.

Which of the following conditions can place a client at risk for acute respiratory distress syndrome (ARDS)? 1. Septic shock. 2. Chronic obstructive pulmonary disease. 3. Asthma. 4. Heart failure.

Which of the following findings would most likely indicate the presence of a respiratory infec- tion in a client with asthma? 1. Cough productive of yellow sputum. 2. Bilateral expiratory wheezing. 3. Chest tightness. 4. Respiratory rate of 30 breaths/minute.

Which outcome is appropriate for the client problem "ineffective gas exchange" for the client recently diagnosed with COPD? 1. The client demonstrates the correct way to pursed-lip breathe. 2. The client lists three (3) signs/symptoms to report to the HCP. 3. The client will drink at least 2,500 mL of water daily. 4. The client will be able to ambulate 100 feet with dyspnea.

Which statement made by the client indicates the nurse's discharge teaching is effective for the client diagnosed with COPD? 1. "I need to get an influenza vaccine each year, even when there is a shortage." 2. "I need to get a vaccine for pneumonia each year with my influenza shot." 3. "If I reduce my cigarettes to six (6) a day, I won't have difficulty breathing." 4. "I need to restrict my drinking liquids to keep from having so much phlegm."

he nurse is suctioning a client who had a laryngectomy. What is the maximum amount of time the nurse should suction the client? ■ 1. 10 seconds. ■ 2. 15 seconds. ■ 3. 25 seconds. ■ 4. 30 seconds.

he nurse is teaching the client and family how to manage possible nausea and vomiting at home. The nurse should include information about: 1. Eating frequent, small meals throughout the day. 2. Eating three normal meals a day. 3. Eating only cold foods with no odor. 4. Limiting the amount of fluid intake.

The nurse is caring for the client diagnosed with ARDS. Which interventions should the nurse implement? Select all that apply. 1. Assess the client's level of consciousness. 2. Monitor urine output every shift. 3. Turn the client every two (2) hours. 4. Maintain intravenous fluids as ordered. 5. Place the client in the Fowler's position.

1,3,4,5

The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a corticos- teroid. Which of the following client actions indi- cates that he is using the MDI correctly? Select all that apply. 1. The inhaler is held upright. 2. The head is tilted down while inhaling the medicine. 3. The client waits 5 minutes between puffs. 4. The mouth is rinsed with water following administration. 5. The client lies supine for 15 minutes follow- ing administration.

1,4

The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for tuberculosis. Which instructions should the nurse include on the list? Select all that apply. 1. Activities should be resumed gradually. 2. Avoid contact with other individuals, except family members, for at least 6 months. 3. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. 4. Respiratory isolation is not necessary, because family members already have been exposed. 5. Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags. 6. When 1 sputum culture is negative, the client is no longer considered infectious and usually can return to former employment.

1,3,4,5

Which nursing interventions should the nurse implement for the client diagnosed with a pulmonary embolus who is undergoing thrombolytic therapy? Select all that apply. 1. Keep protamine sulfate readily available. 2. Avoid applying pressure to venipuncture sites. 3. Assess for overt and covert signs of bleeding. 4. Avoid invasive procedures and injections. 5. Administer stool softeners as ordered.

1,3,4,5

Which of the following is significant data to gather from a client who has been diagnosed with pneumonia? Select all that apply. 1. Quality of breath sounds. 2. Presence of bowel sounds. 3. Occurence of chest pain. 4. Amount of peripheral edema. 5. Color of nail beds.

1,3,5

The case manager is arranging a care planning meeting regarding the care of a 65-year-old client diagnosed with adult-onset asthma. Which health-care disciplines should participate in the meeting? Select all that apply. 1. Nursing. 2. Pharmacy. 3. Social work. 4. Occupational therapy. 5. Speech therapy.

1,2,3

90. A nurse is teaching a client to use a metered- dose inhaler (MDI) to administer his bronchodilator medication. Indicate the correct order of the steps the client should take to use the MDI appropriately. 1. Shake the inhaler immediately before use. 2. Hold breath for 5 to 10 seconds and then exhale. 3. Activate the MDI on inhalation. 4. Breathe out through the mouth.

1,4,3,2

83. A client uses a metered-dose inhaler (MDI) to aid in management of his asthma. Which action by the client indicates to the nurse that he needs further instruction regarding its use? Select all that apply. 1. Activation of the MDI is not coordinated with inspiration. 2. The client inspires rapidly when using the MDI. 3. The client holds his breath for 3 seconds after inhaling with the MDI. 4. The client shakes the MDI after use. 5. The client performs puffs in rapid succession.

1,2,3,4,5

Which client problems are appropriate for the nurse to include in the plan of care for the client diagnosed with COPD? Select all that apply. 1. Impaired gas exchange. 2. Inability to tolerate temperature extremes. 3. Activity intolerance. 4. Inability to cope with changes in roles. 5. Alteration in nutrition.

1,2,3,4,5

Which of the following should be included in the teaching plan for a cancer client who is expe- riencing thrombocytopenia? Select all that apply.. 1. Use an electric razor. 2. Use a soft-bristle toothbrush. 3. Avoid frequent flossing for oral care. 4. Include an over-the-counter nonsteroidal anti- inflammatory (NSAID) daily for pain control. 5. Monitor temperature daily. 6. Report bleeding, such as nosebleed, pete- chiae, or melena, to a health care profes- sional.

1,2,3,6

The nurse has reported to the hospital to work the evening shift on a respiratory unit. The nurse's assignment consists of four clients. Priori- tize in order from highest to lowest priority how the nurse would assess the clients after receiving report. 1. An 85-year-old client with bacterial pneumo- nia, temperature of 102.2° F (42° C), and short- ness of breath. 2. A 60-year-old client with chest tubes who is 2 days postoperative following a thoracotomy for lung cancer and is requesting something for pain. 3. A 35-year-old client with suspected tuberculo- sis who is complaining of a cough. 4. A 56-year-old client with emphysema who has a scheduled dose of a bronchodilator due to be administered, with no report of acute respira- tory distress.

1,2,4,3

The nurse writes a problem of "impaired gas exchange" for a client diagnosed with cancer of the lung. Which interventions should be included in the plan of care? Select all that apply. 1. Apply O2 via nasal cannula. 2. Have the dietitian plan for six (6) small meals per day. 3. Place the client in respiratory isolation. 4. Assess vital signs for fever. 5. Listen to lung sounds every shift.

1,2,4,5

The nurse and a licensed practical nurse (LPN) are caring for five (5) clients on a medical unit. Which clients would the nurse assign to the LPN? Select all that apply. 1. The 32-year-old female diagnosed with exercise-induced asthma who has a forced vital capacity of 1,000 mL. 2. The 45-year-old male with adult-onset asthma who is complaining of difficulty completing all of the ADLs at one time. 3. The 92-year-old client diagnosed with respiratory difficulty who is beginning to be confused and keeps climbing out of bed. 4. The 6-year-old client diagnosed with intrinsic asthma who is scheduled for discharge and the mother needs teaching about the medications. 5. The 20-year-old client diagnosed with asthma who has a pulse oximetry reading of 95% and wants to sleep all the time.

1,2,5

The nurse is caring for the client diagnosed with pneumonia. Which information should the nurse include in the teaching plan? Select all that apply. 1. Place the client on oxygen delivered by nasal cannula. 2. Plan for periods of rest during activities of daily living. 3. Place the client on a fluid restriction of 1,000 mL/day. 4. Restrict the client's smoking to two (2) to three (3) cigarettes per day. 5. Monitor the client's pulse oximetry readings every four (4) hours.

1,2,5

The nurse administers two 325 mg aspirin every 4 hours to a client with pneumonia. The nurse should evaluate the outcome of administering the drug by assessing which of the following? Select all that apply. 1. Decreased pain when breathing. 2. Prolonged clotting time. 3. Decreased temperature. 4. Decreased respiratory rate. 5. Increased ability to expectorate secretions.

1,3

What areas of education should the nurse provide employees in a factory making products that cause respiratory irritation to reduce the risk of laryngeal cancer? Select all that apply. 1. Smoking cessation concurrent with counsel- ing. 2. HEPA filter use in the home. 3. Limiting alcohol use. 4. Brushing teeth after every meal. 5. Raising the voice to be heard over the noise in the factory.

1,3

The community health nurse is conducting an educational session with community members regarding the signs and symptoms associated with tuberculosis. The nurse informs the participants that tuberculosis is considered as a diagnosis if which signs and symptoms are present? Select all that apply. 1. Dyspnea 2. Headache 3. Night sweats 4. A bloody, productive cough 5. A cough with the expectoration of mucoid sputum

1,3,4,5

2A nurse is teaching a client about taking antihistamines. Which of the following instruc- tions should the nurse include in the teaching plan? Select all that apply. 1. Operating machinery and driving may be dangerous while taking antihistamines. 2. Continue taking antihistamines even if nasal infection develops. 3. The effect of antihistamines is not felt until a day later. 4. Do not use alcohol with antihistamines. 5. Increase fluid intake to 2,000 mL/day.

1,4,5

A client with acute respiratory distress syn- drome (ARDS) has fine crackles at lung bases and the respirations are shallow at a rate of 28 breaths/minute. The client is restless and anxious. In addition to moni- toring the arterial blood gas results, the nurse should do which of the following? Select all that apply. 1. Monitor serum creatinine and blood urea nitrogen levels. 2. Administer a sedative.Keep the head of the bed flat. 3. Administer humidified oxygen. 4. Auscultate the lungs.

1,4,5

75. When performing postural drainage, which of the following factors promotes the movement of secretions from the lower to the upper respiratory tract? 1. Friction between the cilia. 2. Force of gravity. 3. Sweeping motion of cilia. 4. Involuntary muscle contractions

76. When teaching a client with chronic obstruc- tive pulmonary disease to conserve energy, the nurse should teach the client to lift objects: 1. While inhaling through an open mouth. 2. While exhaling through pursed lips. 3. After exhaling but before inhaling. 4. While taking a deep breath and holding it.

79. A client with chronic obstructive pulmonary disease (COPD) is experiencing dyspnea and has a low PaO2 level. The nurse plans to administer oxy- gen as ordered. Which of the following statements is true concerning oxygen administration to a client with COPD? 1. High oxygen concentrations will cause cough- ing and dyspnea. 2. High oxygen concentrations may inhibit the hypoxic stimulus to breathe. 3. Increased oxygen use will cause the client to become dependent on the oxygen. 4. Administration of oxygen is contraindicated in clients who are using bronchodilators.

102. Following a thoracotomy, the client has severe pain. Which of the following strategies for pain management will be most effective for this client? 1. Repositioning the client immediately after administering pain medication. 2. Reassessing the client 30 minutes after administering pain medication. 3. Verbally reassuring the client after administering pain medication. 4. Readjusting the pain medication dosage as needed according to the client's condition.

114. A 21-year-old male client is transported by ambulance to the emergency department after a serious automobile accident. He complains of severe pain in his right chest where he struck the steering wheel. Which is the primary client goal at this time? ■ 1. Reduce the client's anxiety. ■ 2. Maintain adequate oxygenation. ■ 3. Decrease chest pain. ■ 4. Maintain adequate circulating volume.

116. A client who is recovering from chest trauma is to be discharged home with a chest tube drainage system intact. The nurse should instruct the client to call the physician for which of the following? 1. Respiratory rate greater than 16 breaths/ minute. 2. Continuous bubbling in the water-seal chamber. 3. Fluid in the chest tube. 4. Fluctuation of fluid in the water-seal chamber.

120. The primary reason for infusing blood at a rate of 60 mL/hour is to help prevent which of the following complications? 1. Emboli formation. 2. Fluid volume overload. 3. Red blood cell hemolysis. 4. Allergic reaction.

128. The nurse interprets which of the following as an early sign of acute respiratory distress syn- drome (ARDS) in a client at risk? 1. Elevated carbon dioxide level. 2. Hypoxia not responsive to oxygen therapy. 3. Metabolic acidosis. 4. Severe, unexplained electrolyte imbalance.

47. Which of the following is an expected out- come for an elderly client following treatment for bacterial pneumonia? 1. A respiratory rate of 25 to 30 breaths/minute. 2. The ability to perform activities of daily liv- ing without dyspnea. 3. A maximum loss of 5 to 10 lb of body weight. 4. Chest pain that is minimized by splinting the rib cage.

67. The nurse reviews an arterial blood gas report for a client with chronic obstructive pulmo- nary disease (COPD).pH 7.35; PC02 62; PO2 70; HCO3 34The nurse should: 1. Apply a 100% non-rebreather mask. 2. Assess the vital signs. 3. Reposition the client. 4. Prepare for intubation.

A 27-year-old female has had elective nasal surgery for a deviated septum. Which of the follow- ing would indicate thaat bleeding was occurring even if the nasal drip pad remained dry and intact? 1. Nausea. 2. Repeated swallowing. 3. Increased respiratory rate. 4. Increased pain.

A 28-year-old client with cancer is afraid of experiencing a febrile reaction associated with blood transfusions. He asks the nurse if this will happen to him. The nurse's best response is which of the fol- lowing? 1. "Febrile reactions are caused when antibod- ies on the surface of blood cells in the trans- fusion are directed against antigens of the recipient." 2. "Febrile reactions can usually be prevented by administering antipyretics and antihista- mines before the start of the transfusion." 3. "Febrile reactions are rarely immune-medi- ated reactions and can be a sign of hemolytic transfusion." 4. "Febrile reactions primarily occur within15 minutes after initiation of the transfusion and can occur during the blood transfusion."

A 36-year-old female is scheduled to receive external radiation therapy and a cesium implant for cancer of the cervix. Which of the following state- ments would be most accurate to include in the teaching plan about the potential effects of radiation therapy on sexuality? 1. "You can have sexual intercourse while the implant is in place." 2. "You may notice some vaginal dryness after treatment is completed." 3. "You may notice some vaginal relaxation after treatment is completed." 4. "You will continue to have normal menstrual periods during treatment."

A 40-year-old female is losing most of her hair as a result of chemotherapy. Which of the following statements best explains chemotherapy- induced alopecia? 1. The new growth of hair will be gray." 2. "The hair loss is temporary." 3. "New hair growth will always be the same texture and color as it was before chemother- apy." 4. "The client should avoid use of wigs when possible."

A client has a positive reaction to the Man- toux test. The nurse correctly interprets this reaction to mean that the client has: 1. Active tuberculosis.Had contact with 2. Mycobacterium tuberculo- sis. 3. Developed a resistance to tubercle bacilli. 4. Developed passive immunity to tuberculosis.

A client with bacterial pneumonia is to be started on I.V. antibiotics. Which of the following diagnostic tests must be completed before antibiotic therapy begins? 1. Urinalysis. 2. Sputum culture. 3. Chest radiograph. 4. Red blood cell count.

A client with tuberculosis is taking Isoniazid (INH). To help prevent development of peripheral neuropathies, the nurse should instruct the client to: 1. Adhere to a low-cholesterol diet. S 2.Supplement the diet with pyridoxine (vitamin B6). 3. Get extra rest. 4. Avoid excessive sun exposure.

A client's arterial blood gas values are as fol- lows: pH, 7.31; PaO2, 80 mm Hg; PaCO2, 65 mm Hg; HCO −, 36 mEq/L. The nurse should assess the client 1. Cyanosis. 2. Flushed skin. 3. Irritability. 4. Anxiety.

A female receiving radiation therapy for lung cancer complains to the nurse that she is having dif- ficulty sleeping. The nurse should: 1. Suggest the client stop watching television before bed. 2. Assess the client's usual sleep patterns, amount of sleep, and bedtime rituals. 3. Tell the client sleeplessness is expected with radiation therapy. 4. Suggest that the client stop drinking coffee until the therapy is completed.

A nurse is assessing a female who is receiv- ing her second administration of chemotherapy for breast cancer. When obtaining this client's health history, what is the most important information the nurse should obtain? 1. "Has your hair been falling out in clumps?" 2. "Have you had nausea or vomiting?" 3. "Have you been sleeping at night?" 4. "Do you have your usual energy level?"

The 56-year-old client diagnosed with tuberculosis (Tb) is being discharged. Which statement made by the client indicates an understanding of the discharge instructions? 1. "I will take my medication for the full three (3) weeks prescribed." 2. "I must stay on the medication for months if I am to get well." 3. "I can be around my friends because I have started taking antibiotics." 4. "I should get a Tb skin test every three (3) months to determine if I am well."

The alert and oriented client is diagnosed with a spontaneous pneumothorax, and the health- care provider is preparing to insert a left-sided chest tube. Which intervention should the nurse implement first? 1. Gather the needed supplies for the procedure. 2. Obtain a signed informed consent form. 3. Assist the client into a side-lying position. 4. Discuss the procedure with the client.

The client diagnosed with ARDS is in respiratory distress and the ventilator is malfunctioning. Which intervention should the nurse implement first? 1. Notify the respiratory therapist immediately. 2. Ventilate with a manual resuscitation bag. 3. Request STAT arterial blood gases. 4. Auscultate the client's lung sounds.

The client diagnosed with asthma is admitted to the emergency department with difficulty breathing and a blue color around the mouth. Which diagnostic test will be ordered to determine the status of the client? 1. Complete blood count. 2. Pulmonary function test. 3. Allergy skin testing. 4. Drug cortisol level.

The client diagnosed with influenza A is being discharged from the emergency department with a prescription for antibiotics. Which statement by the client indicates an understanding of this prescription? 1. "These pills will make me feel better fast and I can return to work." 2. "The antibiotics will help prevent me from developing a bacterial pneumonia." 3. "If I had gotten this prescription sooner, I could have prevented this illness." 4. "I need to take these pills until I feel better; then I can stop taking the rest."

The client diagnosed with lung cancer is in an investigational program and receiving a vaccine to treat the cancer. Which information regardinginvestigational regimens should the nurse teach? 1. Investigational regimens provide a better chance of survival for the client. 2. Investigational treatments have not been proven to be helpful to clients. 3. Clients will be paid to participate in an investigational program. 4. Only clients who are dying qualify for investigational treatments.

The client diagnosed with restrictive airway disease (asthma) has been prescribed a glucocorticoid inhaled medication. Which information should the nurse teach regarding this medication? 1. Do not abruptly stop taking this medication; it must be tapered off. 2. Immediately rinse the mouth following administration of the drug. 3. Hold the medication in the mouth for 15 seconds before swallowing. 4. Take the medication immediately when an attack starts.

The client diagnosed with tonsillitis is scheduled to have surgery in the morning. Which assessment data should the nurse notify the health-care provider about prior to surgery? 1. The client has a hemoglobin of 12.2 g/dL and hematocrit of 36.5%. 2. The client has an oral temperature of 100.2 ̊F and a dry cough. 3. There are one (1) to two (2) white blood cells (WBCs) in the urinalysis. 4. The client's current international normalized ratio (INR) is 1.

The client is diagnosed with mild intermittent asthma. Which medication should the nurse discuss with the client? 1. Daily inhaled corticosteroids. 2. Use of a "rescue inhaler." 3. Use of systemic steroids. 4. Leukotriene agonists.

The client is four (4) hours post-lobectomyfor cancer of the lung. Which assessment data warrant immediate intervention by the nurse? 1. The client has an intake of 1,500 mL IV and an output of 1,000 mL. 2. The client has 450 mL of bright-red drainage in the chest tube. 3. The client is complaining of pain at a "10" on a 1-to-10 scale. 4. The client has absent lung sounds on the side of the surgery.

The client is getting out of bed and becomes very anxious and has a feeling of impending doom. The nurse thinks the client may be experiencing a pulmonary embolism. Which action should the nurse implement first? 1. Administer oxygen 10 L via nasal cannula. 2. Place the client in high Fowler's position. 3. Obtain a STAT pulse oximeter reading. 4. Auscultate the client's lung sounds.

The client is three (3) days post-partial laryngectomy. Which type of nutrition should the nurse offer the client? 1. Total parenteral nutrition. 2. Soft, regular diet. 3. Partial parenteral nutrition. 4. Clear liquid diet.

The client with tuberculosis is to be dis- charged home with community health nursing follow-up. Of the following nursing interventions, which should have the highest priority? 1. Offering the client emotional support. 2. Teaching the client about the disease and its treatment. 3. Coordinating various agency services. 4. Assessing the client's environment for sanita- tion.

The emergency department nurse is assessing a client who has sustained a blunt injury to the chest wall. Which finding indicates the presence of a pneumothorax in this client? 1. A low respiratory rate 2. Diminished breath sounds 3. The presence of a barrel chest 4. A sucking sound at the site of injury

The male client has had a radial neck dissection for cancer of the larynx. Which action by the client indicates a disturbance in body image? 1. The client requests a consultation by the speech therapist. 2. The client has a towel placed over the mirror. 3. The client is attempting to shave himself. 4. The client practices neck and shoulder exercises.

The nurse identified the client problem "decreased cardiac output" for the client diagnosed with a pulmonary embolus. Which intervention should be included in the plan of care? 1. Monitor the client's arterial blood gases 2. Assess skin color and temperature. 3. Check the client for signs of bleeding. 4. Keep the client in the Trendelenburg position.

The nurse in a long-term care facility is planning the care for a client with a percutaneous endoscopic gastrostomy (PEG) feeding tube used for bolus feedings. Which intervention should the nurse include in the plan of care? 1. Inspect the insertion line at the naris prior to instilling formula. 2. Elevate the head of the bed (HOB) after feeding the client. 3. Place the client in the Sims position following each feeding. 4. Change the dressing on the feeding tube every three (3) days.

The nurse is assessing the client diagnosed with COPD. Which data require immediate intervention by the nurse? 1. Large amounts of thick white sputum. 2. Oxygen flowmeter set on eight (8) liters. 3. Use of accessory muscles during inspiration. 4. Presence of a barrel chest and dyspnea.

The nurse is discussing the care of a child diagnosed with asthma with the parent. Which referral is important to include in the teaching? 1. Referral to a dietitian. 2. Referral for allergy testing. 3. Referral to the developmental psychologist. 4. Referral to a home health nurse.

The nurse is feeding a client diagnosedwith aspiration pneumonia who becomes dyspneic, begins to cough, and is turning blue. Which nursing intervention should the nurse implement first? 1. Suction the client's nares .2. Turn the client to the side. 3. Place the client in Trendelenburg position. 4. Notify the health-care provider.

The nurse is preparing to give a bed bath to an immobilized client with tuberculosis. The nurse should wear which items when performing this care? 1. Surgical mask and gloves 2. Particulate respirator, gown, and gloves 3. Particulate respirator and protective eyewear 4. Surgical mask, gown, and protective eyewear

The nurse observes a constant gentle bubbling in the water-seal column of a water-seal chest drain- age system. This observation should prompt the nurse to do which of the following? 1. Continue monitoring as usual; this is expected. 2. Check the connectors between the chest and drainage tubes and where the drainage tube enters the collection bottle. 3. Decrease the suction to -15 cm H2O and continue observing the system for changes in bubbling during the next several hours. 4. Drain half of the water from the water-seal chamber.

The nurse observes the unlicensed assistive personnel (UAP) removing the nasal cannula from the client diagnosed with COPD while ambulating the client to the bathroom. Which action should the nurse implement? 1. Praise the UAP because this prevents the client from tripping on the oxygen tubing. 2. Place the oxygen back on the client while sitting in the bathroom and say nothing. 3. Explain to the UAP in front of the client oxygen must be left in place at all times. 4. Discuss the UAP's action with the charge nurse so appropriate action can be taken.

The nurse should teach clients that the most common route of transmitting tubercle bacilli from person to person is through contaminated: ■ 1. Dust particles. ■ 2. Droplet nuclei. ■ 3. Water. ■ 4. Eating utensils.

The nurse should teach the client with asthma that which of the following is one of the most common precipitating factors of an acute asthma attack? 1. Occupational exposure to toxins. 2. Viral respiratory infections. 3. Exposure to cigarette smoke. 4. Exercising in cold temperatures.

The nurse teaches the client how to instill nose drops. Which of the following techniques is correct? 1. The client uses sterile technique when handling the dropper. 2. The client blows the nose gently before instilling drops. 3. The client uses a new dropper for each instillation. The client sits in a semi-Fowler's position with the head tilted forward after administration of the drops.

The unlicensed assistive personnel (UAP) assists the client with a chest tube to ambulate to the bathroom. Which situation warrants immediate intervention from the nurse? 1. The UAP keeps the chest tube below chest level. 2.TheUAPhasthechesttubeattachedtosuction. 3. The UAP allowed the client out of the bed. 4. The UAP uses a bedside commode for the client.

A client is admitted to the emergency depart- ment with a headache, weakness, and slight confu- sion. The physician diagnoses carbon monoxide poisoning. What should the nurse do first? 1. Initiate gastric lavage. 2. Maintain body temperature. 3. Administer 100% oxygen by mask. 4. Obtain a psychiatric referral.

Which assessment data indicate to the nurse the chest tubes inserted three (3) days ago have been effective in treating the client with a hemothorax? 1. Gentle bubbling in the suction compartment. 2. No fluctuation (tidaling) in the water-seal compartment. 3. The drainage compartment has 250 mL of blood 4. The client is able to deep breathe without any pain.

Which medication should the nurse anticipate the health-care provider ordering for the client diagnosed with ARDS?' 1. An aminoglycoside antibiotic. 2. A synthetic surfactant. 3. A potassium cation. 4. A nonsteroidal anti-inflammatory drug.

Which nursing assessment data support that the client has experienced a pulmonary embolism? 1. Calf pain with dorsiflexion of the foot. 2. Sudden onset of chest pain and dyspnea. 3. Left-sided chest pain and diaphoresis.4 . Bilateral crackles and low-grade fever.

Which of the following activities shouldthe nurse teach the client to implement after the removal of nasal packing on the second postopera- tive day? 1. Avoid cleaning the nares until swelling has subsided. 2. Apply water-soluble jelly to lubricate the nares. 3. Keep a nasal drip pad in place to absorb secretions. 4. Use a bulb syringe to gently irrigate nares.

Which of the following home care instruc- tions would be appropriate for a client with a laryn- gectomy? 1. Perform mouth care every morning and eve- ning. 2. Provide adequate humidity in the home. 3. Maintain a soft, bland diet. 4. Limit physical activity to shoulder and neck exercises.

Which of the following statements should indi- cate to the nurse that a client has understood the dis- charge instructions provided after her nasal surgery? "I should not shower until my packing is removed." "I will take stool softeners and modify my diet to prevent constipation." "Coughing every 2 hours is important to pre- vent respiratory complications." "It is important to blow my nose each day to remove the dried secretions."

Which of the following would be a significant intervention to help prevent lung cancer? 1. Encourage cigarette smokers to have yearly chest radiographs. 2. Instruct people about techniques for smoking cessation. 3. Recommend that people have their houses and apartments checked for asbestos leakage. 4. Encourage people to install central air clean- ers in their homes.

Which task is most appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP)? 1. Feed a client who is postoperative tonsillectomy the first meal of clear liquids. 2. Encourage the client diagnosed with a cold to drink a glass of orange juice. 3. Obtain a throat culture on a client diagnosed with bacterial pharyngitis. 4. Escort the client diagnosed with laryngitis outside to smoke a cigarette.

The nurse is caring for a client with a right-sided chest tube secondary to a pneumothorax. Which interventions should the nurse implement when caring for this client? Select all that apply. 1. Place the client in the low Fowler's position. 2. Assess chest tube drainage system frequently. 3. Maintain strict bedrest for the client. 4. Secure a loop of drainage tubing to the sheet. 5. Observe the site for subcutaneous emphysema.

2,4,5

The nurse is instructing a client with COPD how to do pursed-lip breathing. In which order should the nurse explain the steps to the client? 1. "Breathe in normally through your nose for 2 counts (while counting to yourself, one, two)." 2. "Relax your neck and shoulder muscles." 3. "Pucker your lips as if you were going to whistle." 4. "Breathe out slowly through pursed lips for 4 counts (while counting to yourself, one, two, three, four)."

2,1,3,4

The client is admitted to emergency department complaining of shortness of breath and fever. The vital signs are T 100.4 , P 94, R 26 and BP 134/86. Which concept should the nurse identify and a concern for the client? Select all that apply. 1. Clotting. 2. Oxygenation. 3. Infection. 4. Perfusion. 5. Coping.

2,3

The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which findings would the nurse expect to note on assessment of this client? Select all that apply. 1. A low arterial PCo2 level 2. A hyperinflated chest noted on the chest x-ray 3. Decreased oxygen saturation with mild exercise 4. A widened diaphragm noted on the chest x-ray 5. Pulmonary function tests that demonstrate increased vital

2,3

57. 1. I will need to dispose of my old clothing when I return home." 2. "I should always cover my mouth and nose when sneezing." 3. "It is important that I isolate myself from fam- ily when possible." 4. "I should use paper tissues to cough in and dispose of them promptly." 5. "I can use regular plates and utensils when- ever I eat."

2,4,5

64 A client who has been diagnosed with tuberculosis has been placed on drug therapy. The medication regimen includes rifampin (Rifadin). Which of the following instructions should the nurse include in the client's teaching plan related to the potential adverse effects of rifampin? Select all that apply. 1. Having eye examinations every 6 months. 2. Maintaining follow-up monitoring of liver enzymes. 3. Decreasing protein intake in the diet. 4. Avoiding alcohol intake. 5. The urine may have an orange color.

2,4,5

A 68-year-old male has been receiving monthly doses of chemotherapy for treatment of stage III colon cancer. He comes to the clinic forhis fourth monthly dose. Which laboratory result(s) should be reported to the oncologist before the next dose of chemotherapy is administered? Select all that apply. ■ 1. Hemoglobin of 14.5 g/dL. 2. Platelet count of 40,000/mm3.■ 3. Blood urea nitrogen (BUN) level of 12 mg/dL. ■ 4. White blood cell count of 2,300/mm3.■ 5. Temperature of 101.2° F (38.4° C).■ 6. Urine specific gravity of 1.020.

2,4,5

The client who has undergone a radical neck dissection and tracheostomy for cancer of the larynx is being discharged. Which discharge instructions should the nurse teach? Select all that apply. 1. The client will be able to speak again after the surgery area has healed. 2. The client should wear a protective covering over the stoma when showering. 3. The client should clean the stoma and then apply a petroleum-based ointment. 4. The client should use a humidifier in the room. 5. The client can get a special telephone for communication.

2,4,5

A 56-year-old client who recently had a right pneumonectomy for lung cancer is admitted to the oncology unit with dyspnea and fever. The nurse should: 1. Place the client on the left side. 2. Position the client for postural drainage. 3. Provide education on deep breathing exer- cises. 4. Instruct the client to maintain bed rest with bathroom privileges.

A 62-year-old male with a history of chronic obstructive pulmonary disease (COPD) and meta- static carcinoma of the lung has not responded to radiation therapy and is being admitted to the hos- pice program. The nurse should conduct a focused client assessment for: ■ 1. Ascites. ■ 2. Pleural friction rub. ■ 3. Dyspnea. ■ 4. Peripheral edema.

A client has experienced pulmonary embolism. The nurse should assess for which symptom, which is most commonly reported? 1. Hot, flushed feeling 2. Sudden chills and fever 3. Chest pain that occurs suddenly 4. Dyspnea when deep breaths are taken

A client has had hoarseness for more than 2 weeks. The nurse should: 1. Refer to a health care provider for a prescription for an antibiotic. 2. Instruct the client to gargle with salt water at home. 3. Assess the client for dysphagia. 4. Instruct the client to take a throat analgesic.

A client is receiving streptomycin in the treatment regimen of tuberculosis. The nurse should assess for: 1. Decreased serum creatinine. 2. Difficulty swallowing. 3. Hearing loss. 4. I.V. infiltration.

A client receiving radiation to the head and neck is experiencing stomatitis. The nurse should recommend: ■ 1. Evaluation by a dentist. ■ 2. Alcohol-based mouth wash rinses. ■ 3. Artificial saliva. ■ 4. Vigorous brushing of teeth after each meal.

A client undergoing chemotherapy has a white blood cell count of 2300/mm3; hemoglobin of 9.8 g/dL; platelet count of 80,000/mm3 and potas- sium of 3.8. Which of the following should take priority?■ 1. Blood pressure 136/88. ■ 2. Emesis of 90 mL. ■ 3. Temperature 101° F (38.3° C). ■ 4. Urine output 40 mL/hour.

A client who has been taking flunisolide (Aer- oBid), two inhalations a day, for treatment of asthma. has painful, white patches in his mouth. Which response by the nurse would be most appropriate? 1. "This is an anticipated adverse effect of your medication. It should go away in a couple of weeks." 2. "You are using your inhaler too much and it has irritated your mouth." 3. "You have developed a fungal infection from your medication. It will need to be treated with an antifungal agent." 4. "Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem."

A client with a chest injury has suffered flail chest. The nurse assesses the client for which most distinctive sign of flail chest? 1. Cyanosis 2. Hypotension 3. Paradoxical chest movement 4. Dyspnea, especially on exhalation

A client with acute asthma is prescribed short-term corticosteroid therapy. Which is the expected outcome for the use of steroids in clients with asthma? 1. Promote bronchodilation. 2. Act as an expectorant. 3. Have an anti-inflammatory effect. 4. Prevent development of respiratory infections.

A client with allergic rhinitis is instructed on the correct technique for using an intranasal inhaler. Which of the following statements would demon- strate to the nurse that the client understands the instructions? 1. "I should limit the use of the inhaler to early morning and bedtime use." 2. "It is important to not shake the canister because that can damage the spray device." 3. "I should hold one nostril closed while I insert the spray into the other nostril." "The inhaler tip is inserted into the nostril and pointed toward the inside nostril wall."

A client with pneumonia has a temperature of 102.6° F (39.2° C), is diaphoretic, and has a pro- ductive cough. The nurse should include which of the following measures in the plan of care? 1. Position changes every 4 hours. 2. Nasotracheal suctioning to clear secretions. 3. Frequent linen changes. 4. Frequent offering of a bedpan.

A client with pneumonia is experiencing pleuritic chest pain. The nurse should assess the client for: 1. A mild but constant aching in the chest. 2. Severe midsternal pain. 3. Moderate pain that worsens on inspiration. 4. Muscle spasm pain that accompanies cough- ing.

A client with rib fractures and a pneumotho- rax has a chest tube inserted that is connected to a water-seal chest tube drainage system. The nurse notes that the fluid in the water-seal column is fluc- tuating with each breath that the client takes. What is the significance of this fluctuation? 1. An obstruction is present in the chest tube. 2. The client is developing subcutaneous emphysema. 3. The chest tube system is functioning properly. 4. There is a leak in the chest tube system.

A nurse notes that a client has kyphosis and generalized muscle atrophy. Which of the following problems is a priority when the nurse develops a nursing plan of care? ■ 1. Infection. ■ 2. Confusion. ■ 3. Ineffective coughing and deep breathing. ■ 4. Difficulty chewing solid foods.

A nurse should interpret which of the follow- ing as an early sign of a tension pneumothorax in a client with chest trauma? 1. Diminished bilateral breath sounds. 2. Muffled heart sounds. 3. Respiratory distress. 4. Tracheal deviation.

An elderly client had posterior packing inserted to control a severe nosebleed. After inser- tion of the packing, the client should be closely monitored for which of the following complications? 1. Vertigo. 2. Bell's palsy. 3. Hypoventilation. 4. Loss of gag reflex

Doxorubicin (Adriamycin) is prescribed for a female client with breast cancer. The client is dis- tressed about hair loss. The nurse should do which of the following? 1. Have the client wash and massage the scalp daily to stimulate hair growth. 2. Explain that hair loss is temporary and will quickly grow back to its original appearance. 3. Provide resources for a wig selection before hair loss begins. 4. Recommend that the client limit social con- tacts until hair regrows.

The charge nurse on a surgical floor ismaking assignments. Which client should be assigned to the most experienced registered nurse (RN)? 1. The 36-year-old client who has undergone an antral irrigation for sinusitis yesterday and has moderate pain. 2. The six-(6)-year-old client scheduled for a tonsillectomy and adenoidectomy this morning who will not swallow medication. 3. The 18-year-old client who had a Caldwell- Luc procedure three (3) days ago and has purulent drainage on the drip pad. 4. The 45-year-old client diagnosed with a peritonsillar abscess who requires VPB antibiotic therapy four (4) times a day.

The client diagnosed with ARDS is transferred to the intensive care department and placed on a ventilator. Which intervention should the nurse implement first? 1. Confirm that the ventilator settings are correct. 2. Verify that the ventilator alarms are functioning properly. 3. Assess the respiratory status and pulse oximeter reading. 4. Monitor the client's arterial blood gas results.

The client diagnosed with a community- acquired pneumonia is being admitted to the medical unit. Which nursing intervention has the highest priority? 1. Administer the ordered oral antibiotic immediately (STAT). 2. Order the meal tray to be delivered as soon as possible. 3. Obtain a sputum specimen for culture and sensitivity. 4. Have the unlicensed assistive personnel weigh the client.

The client diagnosed with a pulmonary embolus is in the intensive care department. Which assessment data warrant immediate intervention from the nurse? 1. The client's ABGs are pH 7.36, Pao2 95, Paco2 38, Hco3 24. 2. The client's telemetry exhibits occasional premature ventricular contractions (PVCs). 3. The client's pulse oximeter reading is 90%. 4. The client's urinary output for the 12-hour shift is 800 mL.

The client diagnosed with exercise-induced asthma (EIA) is being discharged. Which information should the nurse include in the discharge teaching? 1. Take two (2) puffs on the rescue inhaler and wait five (5) minutes before exercise. 2. Warm-up exercises will increase the potential for developing the asthma attacks. 3. Use the bronchodilator inhaler immediately prior to beginning to exercise. 4. Increase dietary intake of food high in monosodium glutamate (MSG).

The client had a right-sided chest tube inserted two (2) hours ago for a pneumothorax. Which action should the nurse implement if thereis no fluctuation (tidaling) in the water-seal compartment? 1. Obtain an order for a STAT chest x-ray. 2. Increase the amount of wall suction. 3. Check the tubing for kinks or clots. 4. Monitor the client's pulse oximeter reading.

The client has been diagnosed with chronic sinusitis. Which sign/symptom alerts the nurse to a potentially life-threatening complication? 1. Muscle weakness. 2. Purulent sputum. 3. Nuchal rigidity. 4. Intermittent loss of muscle control.

The client has had a total laryngectomy. Which referral is specific for this surgery? 1. CanSurmount. 2. Dialogue. 3. Lost Chord Club. 4. SmokEnders.

The client is admitted to the outpatient surgery center for a bronchoscopy to rule out cancerof the lung. Which information should the nurse teach? 1. The test will confirm the results of the MRI. 2. The client can eat and drink immediately after the test. 3. The HCP can do a biopsy of the tumor through the scope. 4. There is no discomfort associated with this procedure.

The nurse is preparing to administer the oral anticoagulant warfarin (Coumadin) to a client who has a PT/PTT of 22/39 and an INR of 2.8. What action should the nurse implement? 1. Assess the client for abnormal bleeding. 2. Prepare to administer vitamin K (AquaMephyton). 3. Administer the medication as ordered. 4. Notify the HCP to obtain an order to increase the dose.

The client who smokes two (2) packs of cigarettes a day develops ARDS after a near- drowning. The client asks the nurse, "What is happening to me? Why did I get this?" Which statement by the nurse is most appropriate? 1. "Most people who almost drown end up developing ARDS." 2. "Platelets and fluid enter the alveoli due to permeability instability." 3. "Your lungs are filling up with fluid, causing breathing problems." 4. "Smoking has caused your lungs to bec

The client with a laryngectomy communi- cates to the nurse that he does not want his family to see him. He indicates that he thinks the opening in his throat is disgusting. Which of the following nursing diagnoses would be most appropriate? 1. Deficient knowledge about the care of a stoma. 2. Disturbed personal identity related to change in appearance. 3. Disturbed body image related to neck surgery. 4. Hopelessness related to irreversible changes in body functioning.

The day shift charge nurse on a medical unit is making rounds after report. Which client should be seen first? 1. The 65-year-old client diagnosed with tuberculosis who has a sputum specimen to be sent to the laboratory. 2. The 76-year-old client diagnosed with aspiration pneumonia who has a clogged feeding tube. 3. The 45-year-old client diagnosed with pneumonia who has a pulse oximetry reading of 92%. 4. The 39-year-old client diagnosed with bronchitis who has an arterial oxygenation level of 89%.

The employee health nurse is administering tuberculin skin testing to employees who have possibly been exposed to a client with active tuberculosis (Tb). Which statement indicates the need for radiological evaluation instead of skin testing? 1. The client's first skin test indicates a purple flat area at the site of injection. 2. The client's second skin test indicates a red area measuring four (4) mm. 3. The client's previous skin test was read as positive. 4. The client has never shown a reaction to the tuberculin medication.

The home health-care nurse is talking on the telephone to a male client diagnosed with hypertension and hears the client sneezing. The client tells the nurse he has been blowing his nose frequently. Which question should the nurse ask the client? 1. "Have you had the flu shot in the last two (2) weeks?" 2. "Are there any small children in the home?" 3. "Are you taking over-the-counter medicine for these symptoms?" 4. "Do you have any cold sores associated with your sneezing?"

The nurse administers theophylline (Theo- Dur) to a client. To evaluate the effectiveness of this medication, which of the following drug actions should the nurse anticipate?. 1. Suppression of the client's respiratory infection. 2. Decrease in bronchial secretions. 3. Relaxation of bronchial smooth muscle. 4. Thinning of tenacious, purulent sputum.

The nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients on a medical unit. Which information provided by the UAP warrants immediate intervention by the nurse? 1. The client diagnosed with cancer of the lung has a small amount of blood in the sputum collection cup. 2. The client diagnosed with chronic emphysema is sitting on the side of the bed and leaning over the bedside table. 3. The client receiving Procrit, a biologic response modifier, has a T 99.2 ̊F, P 68, R 24, and BP of 198/102. 4. The client receiving prednisone, a steroid, is complaining of an upset st

The nurse caring for a client who is receiving external beam radiation therapy for treatment of lung cancer should assess the client for which of the following? 1. Diarrhea. 2. Improved energy level. 3. Dysphagia. 4. Normal white blood cell count.

The nurse is admitting a client with a diagnosis of rule-out cancer of the larynx. Which information should the nurse teach? 1. Demonstrate the proper method of gargling with normal saline. 2. Perform voice exercises for 30 minutes three (3) times a day. 3. Explain that a lighted instrument will be placed in the throat to biopsy the area. 4. Teach the client to self-examine the larynx monthly.

The nurse is caring for a 78-year-old male with lung cancer who is receiving chemotherapy. The client states he is not eating well but otherwise feels healthy. Which meal suggestion would be best for this client? 1. Cereal with milk and strawberries. 2. Toast, gelatin dessert, and cookies. 3. Broiled chicken, green beans, and cottage cheese. 4. Steak and french fries.

The nurse is caring for a client after a bronchoscopy and biopsy. Which finding, if noted in the client, should be reported immediately to the primary health care provider? 1. Dry cough 2. Hematuria 3. Bronchospasm 4. Blood-streaked sputum

The nurse is caring for the client diagnosed with COPD. Which outcome requires a revision in the plan of care? 1. The client has no signs of respiratory distress. 2. The client shows an improved respiratory pattern. 3. The client demonstrates intolerance to activity. 4. The client participates in establishing goals.

The nurse is completing the admission assessment on a 13-year-old client diagnosed with an acute exacerbation of asthma. Which signs and symptoms would the nurse expect to find? 1. Fever and crepitus. 2. Rales and hives. 3. Dyspnea and wheezing. 4. Normal chest shape and eupnea.

The nurse is developing a plan of care for a client diagnosed with laryngitis and identifies the client problem "altered communication." Which intervention should the nurse implement? 1. Instruct the client to drink a mixture of brandy and honey several times a day. 2. Encourage the client to whisper instead of trying to speak at a normal level. 3. Provide the client with a blank note pad for writing any communication. 4. Explain that the client's aphonia may become a permanent condition.

The nurse is preparing to administer medications to the following clients. Which medication should the nurse question administering? 1. The oral coagulant warfarin (Coumadin) to the client with an INR of 1.9. 2. Regular insulin to a client with a blood glucose level of 218 mg/dL. 3. Hang the heparin bag on a client with a PT/PTT of 12.9/98. 4. A calcium channel blocker to the client with a BP of 112/82.

The nurse is presenting a class on chest tubes. Which statement best describes a tension pneumothorax? 1. A tension pneumothorax develops when an air- filled bleb on the surface of the lung ruptures. 2. When a tension pneumothorax occurs, the air moves freely between the pleural space and the atmosphere. 3. The injury allows air into the pleural space but prevents it from escaping from the pleural space. 4. A tension pneumothorax results from a puncture of the pleura during a central line placement.

The nurse is working with a client who has cancer to improve the client's independence in activities of daily living after radiation therapy. Which of the following is an appropriate nursing intervention? ■ 1. Refer the client to a community support group after discharge from the rehabilitation unit. ■ 2. Make certain that a family member is present for the rehabilitation sessions.■ 3. Provide positive reinforcement for skills achieved. ■ 4. Inform the client of rehabilitation plans made by the rehabilitation team.

The nurse is writing a care plan for a client newly diagnosed with cancer of the larynx. Which problem is the highest priority? 1. Wound infection. 2. Hemorrhage. 3. Respiratory distress. 4. Knowledge deficit.

The nurse performs an admission assessment on a client with a diagnosis of tuberculosis. The nurse should check the results of which diagnostic test that will confirm this diagnosis? 1. Chest x-ray 2. Bronchoscopy 3. Sputum culture 4. Tuberculin skin test

The nurse should caution sexually active female clients taking isoniazid (INH) that the drug has which of the following effects? 1. Increases the risk of vaginal infection. 2. Has mutagenic effects on ova. 3. Decreases the effectiveness of hormonal con- traceptives. 4. Inhibits ovulation.

The nurse should include which of the following instructions in the teaching plan for a client with chronic sinusitis? 1. Avoid the use of caffeinated beverages. 2. Perform postural drainage every day. 3. Take hot showers twice daily. 4. Report a temperature of 102° F (38.9° C) or higher.

The nurse teaches a client with chronic obstructive pulmonary disease (COPD) to assessfor signs and symptoms of right-sided heart failure. Which of the following signs and symptoms should be included in the teaching plan? 1. Clubbing of nail beds. 2. Hypertension. 3. Peripheral edema. 4. Increased appetite.

The nursing staff on an oncology unit is interviewing applicants for the unit manager position. Which type of organizational structure does this represent? 1. Centralized decision making. 2. Decentralized decision making. 3. Shared governance. 4. Pyramid with filtered-down decisions.

When caring for the client who is receiv- ing an aminoglycoside antibiotic, the nurse should monitor which of the following laboratory values? ■ 1. Serum sodium. ■ 2. Serum potassium. ■ 3. Serum creatinine. ■ 4. Serum calcium.

Which assessment data indicate to thenurse the client diagnosed with ARDS has experienced a complication secondary to the ventilator? 1. The client's urine output is 100 mL in four (4) hours. 2. The pulse oximeter reading is greater than 95%. 3. The client has asymmetrical chest expansion. 4. The telemetry reading shows sinus tachycardia.

Which clinical manifestation should the nurse expect to assess in the client recently diagnosed with COPD? 1. Clubbing of the client's fingers. 2. Infrequent respiratory infections. 3. Chronic sputum production. 4. Nonproductive hacking cough.

Which of the following assessments should be a priority immediately after nasal surgery? 1. Assessing the client's pain. 2. Inspecting for periorbital ecchymosis. 3. Assessing respiratory status. 4. Measuring intake and output.

Which of the following interventions should the nurse anticipate in a client who has been diag- nosed with acute respiratory distress syndrome (ARDS)? 1. Tracheostomy. 2. Use of a nasal cannula. 3. Mechanical ventilation. 4. Insertion of a chest tube.

Which of the following is an appropriate expected outcome for a client recovering from a total laryngectomy? The client will: 1. Regain the ability to taste and smell food. 2. Demonstrate appropriate care of the gastrostomy tube. 3. Communicate feelings about body image changes. 4. Demonstrate sterile suctioning technique for stoma care

Which of the following nursing interventions would be most helpful in making the respiratory effort of a client with metastatic lung cancer more efficient? 1. Teaching the client diaphragmatic breathing techniques. 2. Administering cough suppressants as ordered. 3. Teaching and encouraging pursed-lip breath- ing. 4. Placing the client in a low semi-Fowler's position.

Which of the following rehabilitative mea- sures should the nurse teach the client who has undergone chest surgery to prevent shoulder anky- losis? 1. Turn from side to side. 2. Raise and lower the head. 3. Raise the arm on the affected side over the head. 4. Flex and extend the elbow on the affected side.

Which referral is most appropriate for a client diagnosed with end-stage COPD? 1. The Asthma Foundation of America. 2. The American Cancer Society. 3. The American Lung Association. 4. The American Heart Association.

While assessing a thoracotomy incisional area from which a chest tube exits, the nurse feels a crackling sensation under the fingertips along the entire incision. Which of the following should be the nurse's first action? 1. Lower the head of the bed and call the physician. 2. Prepare an aspiration tray. 3. Mark the area with a skin pencil at the outer periphery of the crackling. 4. Turn off the suction of the chest drainage system.

A nurse is making follow-up phone calls to clients being treated for cancer. Place the options below in the order of priority that the nurse should return the calls. 1. The client receiving chemotherapy who complains of a loss of appetite. 2. The client who underwent a mastectomy 2 weeks ago who called for information on the Reach for Recovery program. 3. The client receiving spinal radiation for bone cancer metastases who complains of urinary incontinence. 4. The client with colon cancer who has questions about a high-fiber diet.

3,1,4,2

The nurse has placed the intubated client with acute respiratory distress syndrome (ARDS) in prone position for 30 minutes. Which of the follow- ing would require the nurse to discontinue prone positioning and return the client to the supine posi- tion? Select all that apply. 1. The family is coming in to visit. 2. The client has increased secretions requiring frequent suctioning. 3. The SpO2 and PO2 have decreased. 4. The client is tachycardic with drop in blood pressure.The face has increased skin breakdown and edema.

3,4,5

10.A health care provider has just inserted nasal packing for a client with epistaxis. The client is taking ramipril (Altace) for hypertension. What should the nurse instruct the client to do? 1. Use 81 mg of aspirin daily for relief of dis- comfort. 2. Omit the next dose of ramipril (Altace). 3. Remove the packing if there is difficulty swal- lowing. 4. Avoid rigorous aerobic exercise.

123. The physician has inserted a chest tube in a client with a pneumothorax. The nurse should evaluate the effectiveness of the chest tube: 1. For administration of oxygen. 2. To promote formation of lung scar tissue. 3. To insert antibiotics into the pleural space. 4. To remove air and fluid.

125. The nurse has calculated a low PaO2/FIO2 (P/F) ratio < 150 for a client with acute respiratory distress syndrome (ARDS). The nurse should place the client in which position to improve oxygenation, ventilation distribution, and drainage of secretions? ■ 1. Supine. ■ 2. Semi-fowlers. ■ 3. Lateral side. ■ 4. Prone.

84. A 34-year-old female with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, which action should the nurse take to initiate care of the client? 1. Initiate oxygen therapy and reassess the client in 10 minutes. 2. Draw blood for an arterial blood gas analysis and send the client for a chest X-ray. 3. Encourage the client to relax and breathe slowly through the mouth. 4. Administer bronchodilators.

A 56-year-old client is receiving chemo- therapy that has the potential to cause pulmonary toxicity. Which of the following symptoms indicates a toxic response to the chemotherapy? 1. Decrease in appetite. 2. Drowsiness. 3. Spasms of the diaphragm. 4. Cough and shortness of breath.

A client has the following arterial blood gas values: pH, 7.52; PaO2, 50 mm Hg; PaCO2, 28 mm Hg; HCO -, 24 mEq/L. The nurse determines that which 3 of the following is a possible cause for these findings? 1. Chronic obstructive pulmonary disease (COPD). 2. Diabetic ketoacidosis with Kussmaul's respirations. 3. Myocardial infarction. 4. Pulmonary embolus.

A client who has had a total laryngectomy appears withdrawn and depressed. He keeps the curtain drawn, refuses visitors, and indicates a desire to be left alone. Which nursing intervention would most likely be therapeutic for the client? 1. Discussing his behavior with his wife to determine the cause. 2. Exploring his future plans. 3. Respecting his need for privacy. 4. Encouraging him to express his feelings non- verbally and in writing.

A client who underwent a left lower lobec- tomy has been out of surgery for 48 hours. She is receiving morphine sulfate via a patient-controlled analgesia (PCA) system. She tells the nurse that she has some pain in her left thorax that worsens when she coughs. The nurse should: 1. Let the client rest, so that she is not stimu- lated to cough. 2. Encourage the client to take deep breaths to help control the pain. 3. Check that the PCA device is functioning properly, and then reassure the client that the machine is working and will relieve her pain. 4. Obtain a more detailed assessment of the cli- ent's pain using a pain scale.

A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms. Which of the following instructions would be appropriate for the nurse to give the client? 1. "Use your nasal decongestant spray regularly to help clear your nasal passages." 2. "Ask the doctor for antibiotics. Antibiotics will help decrease the secretion." 3. "It is important to increase your activity. A daily brisk walk will help promote drainage." 4. "Keep a diary of when your symptoms occur. This can help you identify what precipitates your attacks."

A client's chest tube is to be removed by the physician. Which of the following items should the nurse have ready to be placed directly over the wound when the chest tube is removed? 1. Butterfly dressing. 2. Montgomery strap. 3. Fine-mesh gauze dressing. 4. Petroleum gauze dressing.

A confused client with carbon monoxide poisoning experiences dizziness when ambulating to the bathroom. The nurse should: 1. Put all four side rails up on the bed. 2. Ask the unlicensed personnel to place restraints on the client's upper extremities. 3. Request that the client's roommate put the call light on when the client is attempting to get out of bed. 4. Check on the client at regular intervals to ascertain the need to use the bathroom.

After a thoracotomy, the nurse instructs the client to perform deep-breathing exercises. Which of the following is an expected outcome of these exercises? 1. Deep breathing elevates the diaphragm, which enlarges the thorax and increases the lung surface available for gas exchange. 2. Deep breathing increases blood flow to the lungs to allow them to recover from the trauma of surgery. 3. Deep breathing controls the rate of air flow to the remaining lobe so that it will not become hyperinflated. 4. Deep breathing expands the alveoli and increases the lung surface available for ventilation.

After nasal surgery, the client expresses con- cern about how to decrease facial pain and swelling while recovering at home. Which of the following discharge instructions would be most effective for decreasing pain and edema? 1. Take analgesics every 4 hours around the clock. 2. Use corticosteroid nasal spray as needed to control symptoms. 3. Use a bedside humidifier while sleeping. 4. Apply cold compresses to the area.

Postoperative nursing management of the cli- ent following a radical neck dissection for laryngeal cancer requires: 1. Complete bed rest minimizing head movement. 2. Vital signs once a shift. 3. Clear liquid diet started at 48 hours. 4. Frequent suctioning of the laryngectomy tube.

Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible adverse effect of this drug? 1. Constipation. 2. Bradycardia. 3. Diplopia. 4. Restlessness.

The charge nurse is making client assignments on a medical floor. Which client should the charge nurse assign to the licensed practical nurse (LPN)? 1. The client with pneumonia who has a pulse oximeter reading of 91%. 2. The client with a hemothorax who has Hb of 9 g/dL and Hct of 20%. 3. The client with chest tubes who has jugular vein distention and BP of 96/60. 4. The client who is two (2) hours post- bronchoscopy procedure.

The client diagnosed with cancer of the larynx has had four (4) weeks of radiation therapy to the neck. The client is complaining of severe pain when swallowing. Which scientific rationale explains the pain? 1. The cancer has grown to obstruct the esophagus. 2. The treatments are working on the cancer and the throat is edematous. 3. Cancers are painful and this is expected. 4. The treatments are also affecting the esophagus, causing ulcerations.

The client diagnosed with chronic sinusitis who has undergone a Caldwell-Luc procedure is complaining of pain. Which intervention should the nurse implement first? 1. Administer the narcotic analgesic intravenous push (IVP). 2. Perform gentle oral hygiene. 3. Place the client in semi-Fowler's position. 4. Assess the client's pain

The client diagnosed with oat cell carcinoma of the lung tells the nurse, "I am so tired of all this. I might as well just end it all." Which statement should be the nurse's first response? 1. Say, "This must be hard for you. Would you like to talk?" 2. Tell the HCP of the client's statement. 3. Refer the client to a social worker or spiritual advisor. 4. Find out if the client has a plan to carry out suicide.

The client is admitted to the medical unit diagnosed with a pulmonary embolus. Which intervention should the nurse implement? 1. Administer oral anticoagulants. 2. Assess the client's bowel sounds. 3. Prepare the client for a thoracentesis. 4. Institute and maintain bedrest.

The client is admitted with a diagnosis of rule-out tuberculosis. Which type of isolation procedures should the nurse implement? 1. Standard Precautions. 2. Contact Precautions. 3. Droplet Precautions. 4. Airborne Precautions.

The client with ARDS is on a mechanical ventilator. Which intervention should be included in the nursing care plan addressing the endotracheal tube (ET) care? 1. Do not move or touch the ET tube. 2. Obtain a chest x-ray daily. 3. Determine if the ET cuff is deflated. 4. Ensure that the ET tube is secure.

The clinic nurse is interviewing clients. Which information provided by a client warrants further investigation? 1. The client uses Vicks VapoRub every night before bed. 2. The client has had an appendectomy. 3. The client takes a multiple vitamin pill every day. 4. The client has been coughing up blood in the mornings.

The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the fol- lowing? 1. Decreased cardiac output. 2. Pleural effusion. 3. Inadequate peripheral circulation. 4. Decreased oxygenation of the blood.

The nurse assesses the respiratory statusof a client who is experiencing an exacerbationof chronic obstructive pulmonary disease (COPD) secondary to an upper respiratory tract infection. Which of the following findings would be expected? ■ 1. Normal breath sounds. ■ 2. Prolonged inspiration. ■ 3. Normal chest movement. ■ 4. Coarse crackles and rhonchi.

The nurse has conducted discharge teaching with a client diagnosed with tuberculosis who has been receiving medication for 2 weeks. The nurse determines that the client has understood the information if the client makes which statement? 1. "I need to continue medication therapy for 1 month." 2. "I can't shop at the mall for the next 6 months." 3. "I can return to work if a sputum culture comes back negative." 4. "I should not be contagious after 2 to 3 weeks of medication therapy."

The nurse is assessing the client with COPD. Which health promotion information is most important for the nurse to obtain? 1. Number of years the client has smoked. 2. Risk factors for complications. 3. Ability to administer inhaled medication. 4. Willingness to modify lifestyle.

The nurse is assessing the respiratory status of a client who has suffered a fractured rib. The nurse should expect to note which finding? 1. Slow, deep respirations 2. Rapid, deep respirations 3. Paradoxical respirations 4. Pain, especially with inspiration

The nurse is caring for a client with a right- sided chest tube that is accidentally pulled out of the pleural space. Which action should the nurse implement first? 1. Notify the health-care provider to have chest tubes reinserted STAT. 2. Instruct the client to take slow shallow breaths until the tube is reinserted. 3. Take no action and assess the client's respiratory status every 15 minutes. 4. Tape a petroleum jelly occlusive dressing on three (3) sides to the insertion site.

The nurse is caring for the client diagnosed with end-stage COPD. Which data warrant immediate intervention by the nurse? 1. The client's pulse oximeter reading is 92%. 2. The client's arterial blood gas level is 74. 3. The client has SOB when walking to the bathroom. 4. The client's sputum is rusty colored.

The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which position should the nurse instruct the client to assume? 1. Sitting up in bed 2. Side-lying in bed 3. Sitting in a recliner chair 4. Sitting up and leaning on an overbed table

The nurse is planning the care of a client diagnosed with pneumonia and writes a problem of "impaired gas exchange." Which is anexpected outcome for this problem? 1. Performs chest physiotherapy three (3) times a day. 2. Able to complete activities of daily living. 3. Ambulates in the hall several times during each shift. 4. Alert and oriented to person, place, time, and events.

The nurse is planning to give preoperative instructions to a client who will be undergoing rhinoplasty. Which of the following instructions should be included? 1. After surgery, nasal packing will be in place for 7 to 10 days. 2. Normal saline nose drops will need to be administered preoperatively. 3. The results of the surgery will be immediately obvious postoperatively. 4. Aspirin-containing medications should not be taken for 2 weeks before surgery.

The nurse is preparing the client diagnosed with laryngeal cancer for a laryngectomy in the morning. Which intervention is the nurse's priority? 1. Take the client to the intensive care unit for a visit. 2. Explain that the client will need to ask for pain medication. 3. Demonstrate the use of an antiembolism hose. 4. Find out if the client can read and write.

The nurse is taking the social history from a client diagnosed with small cell carcinoma of the lung. Which information is significant for this disease? 1. The client worked with asbestos for a short time many years ago. 2. The client has no family history for this type of lung cancer. 3. The client has numerous tattoos covering both upper and lower arms. 4. The client has smoked two (2) packs of

The nurse is teaching a client how to manage a nosebleed. Which of the following instructions would be appropriate to give the client? 1. "Tilt your head backward and pinch your nose." 2. "Lie down flat and place an ice compress over the bridge of the nose." 3. "Blow your nose gently with your neck flexed." 4. "Sit down, lean forward, and pinch the soft portion of your nose."

The nurse provides discharge instructions to a client with pulmonary sarcoidosis. The nurse concludes that the client understands the information if the client indicates to report which early sign of exacerbation? 1. Fever 2. Fatigue 3. Weight loss 4. Shortness of breath

The nurse should place a client being admit- ted to the hospital with suspected tuberculosis on what type of isolation? ■ 1. Standard precautions. ■ 2. Contact precautions. ■ 3. Droplet precautions. ■ 4. Airborne precautions.

The school nurse is presenting a class to students at a primary school on how to prevent the transmission of the common cold virus. Which information should the nurse discuss? 1. Instruct the children to always keep a tissue or handkerchief with them. 2. Explain that children current with immunizations will not get a cold. 3. Tell the children they should go to the doctor if they get a cold. 4. Demonstrate to the students how to wash hands correctly.

What is the rationale that supports multidrug treatment for clients with tuberculosis? 1. Multiple drugs potentiate the drugs' actions. 2. Multiple drugs reduce undesirable drug adverse effects. 3. Multiple drugs allow reduced drug dosages to be given. 4. Multiple drugs reduce development of resis- tant strains of the bacteria.

When caring for a client with a chest tube and water-seal drainage system, the nurse should: 1. Verify that the air vent on the water-seal drainage system is capped when the suction is off. 2. Strip the chest drainage tubes at least every 4 hours if excessive bleeding occurs. 3. Ensure that the chest tube is clamped when moving the client out of the bed. 4. Make sure that the drainage apparatus is always below the client's chest level

When instructing clients on how to decrease the risk of chronic obstructive pulmonary disease (COPD), the nurse should emphasize which of the following? 1. Participate regularly in aerobic exercises. 2. Maintain a high-protein diet. 3. Avoid exposure to people with known respiratory infections. 4. Abstain from cigarette smoking.

Which of the following family members exposed to tuberculosis would be at highest risk for contracting the disease?■ 1. 45-year-old mother. ■ 2. 17-year-old daughter. ■ 3. 8-year-old son. ■ 4. 76-year-old grandmother.

Which of the following findings would suggest pneumothorax in a trauma victim? 1. Pronounced crackles. 2. Inspiratory wheezing. 3. Dullness on percussion. 4. Absent breath sounds

Which of the following interventions would be most likely to prevent the development of acute respiratory distress syndrome (ARDS)? 1. Teaching cigarette smoking cessation. 2. Maintaining adequate serum potassium levels. 3. Monitoring clients for signs of hypercapnia. 4. Replacing fluids adequately during hypovolemic states.

Which of the following is an appropriate expected outcome for an adult client with well- controlled asthma? 1. Chest X-ray demonstrates minimal hyperinflation. 2. Temperature remains lower than 100° F (37.8° C). 3. Arterial blood gas analysis demonstrates a decrease in PaO2. 4. Breath sounds are clear.

Which of the following is an expected outcome of pursed-lip breathing for clients with emphysema? 1. To promote oxygen intake. 2. To strengthen the diaphragm. 3. To strengthen the intercostal muscles. 4. To promote carbon dioxide elimination.

Which of the following measures would most likely be successful in reducing pleuritic chest pain in a client with pneumonia? 1. Encourage the client to breathe shallowly. 2. Have the client practice abdominal breathing. 3. Offer the client incentive spirometry. 4. Teach the client to splint the rib cage when coughing.

Which of the following nursing interventions would promote effective airway clearance in a client with acute respiratory distress?■ 1. Administering oxygen every 2 hours. ■ 2. Turning the client every 4 hours. ■ 3. Administering sedatives to promote rest. ■ 4. Suctioning if cough is ineffective.

Which of the following would be an expected outcome for a client recovering from an upper respi- ratory tract infection? The client will: 1. Maintain a fluid intake of 800 mL every24 hours. 2. Experience chills only once a day. 3. Cough productively without chest discomfort. 4. Experience less nasal obstruction and discharge.

Which one of the following assessments is most appropriate for determining the correct place- ment of an endotracheal tube in a mechanically ventilated client? 1. Assessing the client's skin color. 2. Monitoring the respiratory rate. 3. Verifying the amount of cuff inflation. 4. Auscultating breath sounds bilaterally.

Which statement by the client diagnosed with a pulmonary embolus indicates the discharge teaching is effective? 1. "I am going to use a regular-bristle toothbrush." 2. "I will take antibiotics prior to having my teeth cleaned." 3. "I can take enteric-coated aspirin for my headache." "4. I will wear a Medic Alert band at all times."

Which statement indicates to the nurse the client diagnosed with asthma understands the teaching regarding mast cell stabilizer medications? 1. "I should take two (2) puffs when I begin to have an asthma attack." 2. "I must taper off the medications and not stop taking them abruptly." 3. "These drugs will be most effective if taken at bedtime." 4. "These drugs are not good at the time of an attack."

Which statement made by the client diagnosed with chronic bronchitis indicates to the nurse more teaching is required? 1. "I should contact my health-care provider if my sputum changes color or amount." 2. "I will take my bronchodilator regularly to prevent having bronchospasms." 3. "This metered-dose inhaler gives a precise amount of medication with each dose." 4. "I need to return to the HCP to have my blood drawn with my annual physical."

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