Medical Surgical Nursing Chapter 28 Lower Respiratory Problems

4 Because the patient is having respiratory difficulty, the nurse should ask specific questions about this episode and perform a physical assessment of this system. Further history taking and physical examination of other body systems can proceed once the patient's acute respiratory distress is being managed. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question. Text Reference - p. 555

A 71-year-old patient is admitted with acute respiratory distress related to cor pulmonale. Which nursing intervention is most appropriate during admission of this patient? 1 Perform a comprehensive health history with the patient to review prior respiratory problems. 2 Complete a full physical examination to determine the effect of the respiratory distress on other body functions. 3 Delay any physical assessment of the patient and review with the family the patient's history of respiratory problems. 4 Perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress.

2 Because the patient is having respiratory difficulty, the nurse should ask specific questions about this episode and perform a physical assessment of this system. The priority assessment is lung sounds to evaluate for the presence of adverse reactions secondary to tumors, including pneumothorax, pneumonia, and obstruction. Temperature, oxygen saturation, and capillary refill should be assessed after assessment of the lungs. Text Reference - p. 540

A 71-year-old patient with dyspnea secondary to metastatic lung cancer is admitted to the hospital. What should the nurse assess first? 1 Temperature 2 Lung sounds 3 Oxygen saturation 4 Capillary refill

3 Rust-colored sputum is indicative of pneumococcal pneumonia. Tuberculosis frequently presents with a dry cough. Pink frothy sputum would be present in CHF and pulmonary edema. A pulmonary embolus would produce hemoptysis. Text Reference - p. 524

A 72-year-old patient is in the emergency department with a temperature of 101.4° F and a productive cough with rust-colored sputum. The nurse notifies the health care provider, understanding these findings are indicative of which condition? 1 Tuberculosis 2 Chronic heart failure (CHF) 3 Pneumonia 4 Pulmonary embolus

4 Because there are mixed bacteria in a lung abscess, starting a broad spectrum antibiotic is the appropriate treatment option. Postural drainage and chest physiotherapy are not recommended, because they may cause spillage of infection to other bronchi and spread the infection. Reducing fluid intake is not advisable; instead, adequate fluid intake is recommended. Text Reference - p. 534

A patient presents with a lung abscess. What treatment option would be the most appropriate? 1 Postural drainage 2 Chest physiotherapy 3 Reduction of fluid intake 4 Antibiotic treatmen

2 Atelectasis is a condition where the lungs are collapsed as a result of closure of the pores of Kohn and airless alveoli. After thoracic surgery, a patient should take complete bed rest. The patient with atelectasis has diminished sounds or the absence of breath sounds and there is a dullness upon percussion on the affected area. Loud breath sounds similar to the squeaking of a door can be heard in the patient with pleurisy during inspiration. Crackling, wheezing, and accentuation of pulmonic breath sound are heard in the patient with pulmonary embolism. The patient with secondary pulmonary arterial hypertension may have an increased pulmonic heart sound and right-sided fourth heart sound. Text Reference - p. 550

A patient recovering from thoracic surgery reports shortness of breath and the patient's atrial blood gas report reveals an oxygen saturation of 72 percent. The nurse suspects that the patient may have atelectasis. Which observation by the nurse upon auscultation confirms the diagnosis? 1 Loud squeaking sounds during inspiration 2 Diminished breath sounds with dullness to percussion 3 Crackling, wheezing, and accentuation of pulmonic breath sound 4 Increased pulmonic heart sound and right-sided fourth heart sound

3 The patient's clinical picture is consistent with pulmonary embolus, and the first action the nurse should take is to assist the patient. For this reason, the nurse should sit the patient up as tolerated and apply oxygen before notifying the health care provider. An antihypertensive or an ECG may be prescribed at a later time; however, the priority is airway, breathing, and circulation. The health care provider should be notified after the nurse has assessed the patient. Text Reference - p. 576

A patient with asthma who has undergone a total hip replacement complains on the third postoperative day of shortness of breath and slight chest pain and notes that "something is wrong." Temperature is 98.8° F, blood pressure 168/98 mm Hg, pulse 96, respirations 32, and oxygen saturation is 89% on room air. What is the priority nursing action? 1 Administer the prescribed antihypertensive medication and reassess in 15 minutes 2 Obtain an electrocardiogram (ECG) and administer albuterol nebulizers 3 Apply oxygen and place the patient in a semi-Fowler's position 4 Notify the health care provider and document the vital signs

2 A low resistance and low pressure is maintained in the pulmonary circulation at normal conditions. A patient with pulmonary hypertension may have a pulmonary artery pressure of 25 mm Hg or more when at rest. Normal pulmonary artery pressure is 12 to 16 mm Hg. Therefore, 15 mm Hg is a normal pressure maintained in the pulmonary artery. About 30 mm Hg pressure is maintained in the patient after exercise. A pressure of 45 mm Hg may be lethal in the patient. Text Reference - p. 553

What is the pulmonary artery pressure in a patient with pulmonary hypertension, at rest? 1 15 mm Hg 2 25 mm Hg 3 30 mm Hg 4 45 mm Hg

2 Chills often occur in cycles and last for 10 to 30 minutes at a time. They usually signal the onset of an increase in temperature. For this reason, the nurse should provide a light blanket for comfort, but avoid overheating the patient with heat on the neck or bathing in hot water. Acetaminophen would be used if the patient became febrile following the chills. Text Reference - p. 528

Which strategy by the nurse would be most helpful in treating a patient with pneumonia and asthma who is experiencing chills? 1 Apply heat to the patient's posterior neck 2 Provide a blanket to the patient 3 Encourage the patient to bathe in hot water 4 Administer acetaminophen (Tylenol) 650 mg as prescribed

3 Clamping of chest tubes is generally contraindicated. Clamping would allow a buildup of secretions or air in the pleural space and inhibit lung expansion. Patients with chest tubes are usually placed in the semi-Fowler's position for the sake of comfort and ease of breathing. Fluid intake is not a major concern in light of the information provided. Administering the patient's prescribed narcotic analgesic before activity is an expected standard of care for this patient. Text Reference - p. 546

A new nurse is observed caring for a patient who has a chest tube in place after a partial lobectomy. Which action by the nurse is inappropriate and requires a more experienced nurse to intervene? 1 Positioning the patient in a semi-Fowler's position 2 Encouraging the patient to increase his fluid intake 3 Clamping the chest tube while the patient is ambulating to the bathroom 4 Administering the patient's prescribed narcotic analgesic before activity

1, 4 Pulmonary function tests are used to differentiate restrictive pulmonary disorders from obstructive disorders. Reduction in vital capacity and total lung capacity indicates that the patient has restrictive pulmonary disorder. Both atelectasis and pulmonary fibrosis are examples of restrictive disorders. Emphysema, chronic bronchitis, and asthma are obstructive pulmonary disorders and are highly unlikely to be seen in this patient. Text Reference - p. 549

A nurse is assessing the pulmonary functions of a patient and finds that the vital capacity and total lung capacity are reduced. What respiratory disorders could cause the reduced capacities? Select all that apply. 1 Atelectasis 2 Emphysema 3 Chronic bronchitis 4 Pulmonary fibrosis 5 Asthma

1 Culture and Gram stain of sputum is required for prescribing specific antibiotics. However, if there is a delay in obtaining the lab reports, antibiotic administration should not be delayed. Deferring the antibiotics may lead to increased morbidity and mortality because the infection can worsen. Taking the sample again to send to a different lab would not be helpful because the lab will take a similar amount of time to provide the report. Chest physiotherapy can be advised later once the antibiotic therapy is started. Text Reference - p. 525

A nurse is caring for a patient who experiences shortness of breath, severe productive cough, and fever. The sputum, which is yellow, has been sent for laboratory testing, but the lab report is pending. What should be the next step in managing the patient? 1 Administer antibiotics. 2 Wait for the lab report. 3 Retake sputum sample and send to another lab. 4 Refer the patient for chest physiotherapy.

1 The nurse should monitor a patient with pulmonary embolism who is on warfarin therapy for complications such as hematomas, bruising, and bleeding. Polycythemia in a patient with cor pulmonale is secondary to chronic obstructive pulmonary disease. B type natriuretic peptide and serum troponin levels are elevated in patients with increased mortality due to pulmonary embolism. White blood cell differentials are helpful to assess pulmonary embolism. Text Reference - p. 552

A nurse is caring for a patient with a pulmonary embolism who is on warfarin therapy. Which parameter should the nurse monitor in this patient? 1 Hematomas 2 Polycythemia 3 B type natriuretic peptide 4 White blood cell differentials

4 Whenever the bubbling increases, the nurse should suspect an air leak. To look for the point of leak, the nurse should clamp the tube to the chest and see if it is from the patient's chest. Then the nurse should mark the tube and move the clamps methodically away from the chest. If the leak stops at a particular point, this indicates that the leak was between these two points. Therefore the air leak was from the tube between points 3 and 4. Text Reference - p. 547

A nurse is monitoring the chest drainage system of a patient and finds that bubbling has increased. The nurse then marks the whole tube with the numbers 1, 2, 3, 4, and 5 at increments and clamps the tube methodically. The nurse finds that the leak stopped when the clamps were between 3 and 4. What does this indicate? 1 The air leak was from the patient's chest. 2 The air leak was from the tube between points 1 and 2. 3 The air leak was from the tube between points 4 and 5. 4 The air leak was from the tube between points 3 and 4.

3 As many as 90% of patients with lung cancer have a history of cigarette smoking. Cigarette smoke contains several organ-specific carcinogens. Genetics and occupational exposure are risks but not as high as cigarette smoking. Chewing tobacco is not associated with lung cancer; it is related to oral cancer. Text Reference - p. 535

A nurse preparing educational information about lung cancer notes that the primary risk factor related to the development of lung cancer is: 1 Genetics 2 Chewing tobacco 3 Cigarette smoking 4 Occupational exposure

1 A nurse should be aware of some of the common side effects of antitubercular drugs like rifampin, one of which is orange discoloration of body fluids such as urine, sweat, tears, and sputum. It may also cause hepatitis. Liver damage can lead to jaundice, which usually presents as yellowish discoloration of urine and sclera. However it is highly unlikely that tuberculosis has spread to the liver. The alcohol intake of the patient is within normal limits, and so it is not correct to say that alcohol may have damaged the liver. It is also inappropriate to advise the patient to stop taking antitubercular drugs. Text Reference - p. 531

A patient began taking antitubercular drugs a week ago. The nurse reviews the patient's medical record and learns that the patient has a 10-year history of consuming one standard drink of alcohol three times a week. The patient states, "In the last week, my urine turned orange and I am very worried about it." How should the nurse respond? 1 Inform the patient that it is one of the side effects of the antitubercular drug rifampin. 2 Recognize that the tuberculosis may have spread to the liver, and further medical consultation is required. 3 Recognize that the liver may be damaged due to alcohol, and so a liver function test should be performed. 4 Instruct the patient to stop taking antitubercular drugs immediately and consult the primary health care provider.

2 An area of 12 mm of induration at the injection site 48 hours after a Mantoux test is considered significant for a past or current tuberculin infection. An induration of less than 5 mm is considered a negative result. The other answer options are incorrect conclusions related to the findings. Text Reference - p. 530

A patient had an intradermal tuberculin skin test (Mantoux) administered 48 hours ago. The nurse assesses the injection site and identifies a 12-mm area of palpable induration. How should the nurse interpret this result? 1 Definitive evidence that the patient does not have tuberculosis 2 A significant indication that the patient has been exposed to tuberculosis 3 Delayed hypersensitivity with a high likelihood of infection with tuberculosis 4 A negative test that cannot be interpreted as ruling out the presence of tuberculosis

3 A penetrating wound of the chest may be referred to as a sucking chest wound, because air enters the pleural space during inspiration through the chest wall. Surgical thoracotomy can cause sucking chest wounds and result in traumatic pneumothorax. Tension pneumothorax is the condition associated with accumulation of air in pleural space, resulting in lung compression. Iatrogenic pneumothorax is trauma to the chest wall that occurs during a medical procedure such as thoracentesis. Spontaneous pneumothorax is chest wall trauma that is associated with rupture of small blebs. Text Reference - p. 542

A patient has a sucking chest wound due to a surgical thoracotomy. Which type of pneumothorax does the nurse expect? 1 Tension pneumothorax 2 Iatrogenic pneumothorax 3 Traumatic pneumothorax 4 Spontaneous pneumothorax

3 The most common manifestation of a lung abscess is cough-producing purulent sputum (often dark brown) that is foul smelling and foul tasting. Hemoptysis is common, especially when an abscess ruptures into a bronchus. Other common manifestations are fever, chills, prostration, night sweats, pleuritic pain, dyspnea, anorexia, and weight loss. Physical examination of the lungs indicates dullness to percussion and decreased breath sounds on auscultation over the involved segment of lung. Vomiting is not a manifestation of a lung abscess. Text Reference - p. 534

A patient has been admitted with a suspected lung abscess. During the assessment, the nurse is aware that the most common manifestation of a lung abscess is which of these? 1 Fever 2 Vomiting 3 Purulent sputum that has a foul odor and taste 4 Increased breath sounds on auscultation over the involved segment of lung.

2 A chest x-ray examination is the first diagnostic test for lung cance,r because it helps identify the lung mass or evident infiltrate. A biopsy is a diagnostic test for cancer that is performed after computed tomography scans. Computed tomography (CT) scans help to further evaluate the lung mass after the its identification on a chest x-ray. Sputum cytology studies help to identify the malignancy of cancer cells; they are not the first test performed to identify the lung cancer. Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies. Text Reference - p. 538

A patient has clinical manifestations that correlate with a diagnosis of lung cancer. For what test does the nurse initially prepare the patient? 1 Biopsy 2 Chest x-ray 3 Computed tomography 4 Sputum cytology studies

4 Immediate anticoagulation is required for patients with PE. Subcutaneous administration of low-molecular-weight heparin (LMWH; e.g., enoxaparin) has been found to be safer and more effective than use of unfractionated heparin. It is the recommended choice of treatment for patients with nonmassive PE. Warfarin should be initiated within the first three days of heparinization and typically is administered for three to six months. Thrombolytic therapy in PE is done in cases of hemodynamic instability and right ventricular dysfunction. Text Reference - p. 553

A patient has just been admitted to the intensive care unit with a suspected diagnosis of pulmonary embolism (PE). The patient's condition is stable. The nurse will prepare for which intervention? 1 Oral administration of warfarin 2 Thrombolytic therapy with alteplase 3 Intravenous administration of unfractionated heparin 4 Subcutaneous administration of enoxaparin

2 An intrathoracic spread of malignancy in patients with lung cancer may cause dysphagia. Anorexia is a nonspecific systemic symptom of lung cancer. Laryngeal nerve involvement may cause hoarseness. A persistent cough is one of the most common and first symptoms of lung cancer. Text Reference - p. 538

A patient is diagnosed with intrathoracic metastasis from lung cancer. What clinical manifestation assessed by the nurse is related to this diagnosis? 1 Anorexia 2 Dysphagia 3 Hoarseness 4 Persistent cough

2, 4, 1, 3 In photodynamic therapy, porfirmer is injected intravenously. This drug concentrates in tumor cells. After some time, the tumor is exposed to laser light. This exposure activates the drug, which will subsequently destroy the tumor cells. Text Reference - p. 539

A patient is scheduled to have photodynamic therapy and the nurse is educating the patient regarding the procedure. How should the nurse discuss the steps in chronologic order? 1. The drug is activated. 2. Porfirmer is injected. 3. The tumor cell is destroyed. 4. The tumor is exposed to laser light.

1 A cough is the systemic symptom of lung cancer. Nausea, vomiting, anorexia, and weight loss are nonspecific systemic symptoms of lung cancer. Text Reference - p. 538

A patient is suspected of having lung cancer. What specific systemic symptom will the nurse question the patient regarding? 1 Cough 2 Nausea 3 Anorexia 4 Weight loss

2, 4, 5 Magnetic resonance imaging (MRI) and positron emission tomography (PET) are used to evaluate the stage of lung cancer. Computed tomography (CT) is used to identify the location and the extent of the tumor mass. So MRI, PET, and CT are appropriate diagnostic tests to determine the stage, location, and extent of lung cancer. A chest x-ray is the initial diagnostic test used to identify the lung mass; it does not show the extent of the involvement. Sputum cytologic studies are used to detect the malignant cells in sputum. Because malignant cells are not always present in the sputum, it is not a definitive diagnostic study. Test-Taking Tip: Recollect the diagnostic studies and correlate it with question stem. Text Reference - p. 538

A patient is suspected to have stage II A lung cancer. About what diagnostic tests will the nurse educate the patient that will be used to confirm the diagnosis? Select all that apply. 1 Chest x-ray 2 Computed tomography 3 Sputum cytologic studies 4 Magnetic resonance imaging 5 Positron emission tomography

1 Sildenafil should not be given to patients who are on nitroglycerin, because it can lead to refractory hypotension. Therefore sildenafil should be stopped immediately. Thyroxine does not interact with sildenafil and also does not cause hypotension. Lung transplantation is reserved for patients with pulmonary hypertension who do not respond to drug therapy. Administering intravenous fluids without correcting the cause will not help the patient. Text Reference - p. 555

A patient is taking sildenafil for treatment of pulmonary hypertension. The nurse who is monitoring the patient finds that the patient's blood pressure has dropped to 80/60 mm Hg. The patient's current home medications include multivitamins, thyroxine, and nitroglycerin for comorbid conditions. The nurse contacts the primary health care provider and expects what change in the patient's treatment plan? 1 Stopping sildenafil 2 Stopping thyroxine 3 Lung transplantation 4 Administering intravenous fluids

3 The conditions mentioned in the question stem (chest pain, dyspnea, increased pulmonic and right-sided S4 heart sound, peripheral edema, and hepatomegaly), are manifestations of secondary pulmonary arterial hypertension (SPAH). A patient with chronic SPAH caused by thromboembolism may benefit from a thromboendarterectomy. Phlebotomy is performed in a patient with cor pulmonale and chronic hypoxia, which cause severe polycythemia. Atrial septostomy is used in patients with pulmonary hypertension and involves the creation of an intraatrial shunt to decompress the right ventricle. Pulmonary embolectomy is performed in hemodynamically unstable patients with pulmonary embolism. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses. Text Reference - p. 554

A patient with chest pain and dyspnea has increased pulmonic and right-sided S4 heart sound. The nurse finds peripheral edema along with a swollen, soft liver. Which treatment strategy may benefit this patient? 1 Phlebotomy 2 Atrial septostomy 3 Thromboendarterectomy 4 Pulmonary embolectomy

2 Pleural fluid flow is balanced by hydrostatic pressure, oncotic pressure, and membrane permeability. Pleural fluid is clear during transudate pleural effusion in a patient with a liver disorder. It is caused by hypoalbuminemia, which causes a decrease in oncotic pressure. Obstruction of lymph flow leads to the accumulation of pleural fluid in the pleural space. The patient with heart failure has transudate plural effusion due to increased hydrostatic pressure. Increased capillary permeability causes exudative effusion, which is common with infections and malignancies. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - p. 549

A patient with clear pleural fluid and cirrhosis has serum albumin levels of 1.5 g/dL. Which condition is suspected in this patient? 1 Obstructed lymphatic flow 2 Decreased oncotic pressure 3 Elevated hydrostatic pressure 4 Increased capillary permeability

1 A patient with heart failure and a pulmonary arterial pressure of 28 mm Hg when at rest may have pulmonary hypertension. This may lead to hypoxia; therefore, the patient must be supplied with low oxygen flow to provide symptomatic relief. Positioning the patient at an angle of 90 degrees indicates full Fowler's position, which may exacerbate symptoms in this patient. Intravenous fluid infusion may not relieve the patient's symptoms. Warm and cold compresses may benefit the patient with chest pain. Test-Taking Tip: A patient with vascular contraction and heart failure can readily supply blood to the tissues. Therefore, select the intervention that may help to decrease the workload of the patient's heart. Text Reference - p. 554

A patient with heart failure has a pulmonary arterial pressure of 28 mm Hg when at rest. Which intervention helps in comforting this patient? 1 Supplying oxygen to the patient 2 Positioning the patient at an angle of 90 degrees 3 Infusing intravenous fluids to the patient 4 Applying warm and cold compress to the patient

4 Individuals at risk for opportunistic pneumonia include those with altered immune responses, such as HIV infection. In addition to the risk of bacterial and viral pneumonia, the immunocompromised person may develop an infection from microorganisms that do not normally cause disease, such as P.jiroveci (formerly carinii). The patient likely does not have aspiration pneumonia, hospital-associated pneumonia, or community-acquired pneumonia. Text Reference - p. 523

A patient with human immunodeficiency virus (HIV) infection has been admitted with pneumonia. The nurse anticipates that this patient will receive treatment for which type of pneumonia? 1 Aspiration pneumonia 2 Hospital-associated pneumonia 3 Community-acquired pneumonia 4 Opportunistic pneumonia caused by Pneumocystis jiroveci

2 Hypoxemia, sudden alterations in mental status, chest pain, and hemoptysis are manifestations of pulmonary embolism. Serum troponin of 2.08 ng/mL (normal value: below 0.01 to 0.09 ng/mL) and B type natriuretic peptide of 600 pg/mL (normal value: below 100 pg/mL) indicates increased mortality. Therefore, anticoagulants may provide relief from the symptoms by dissolving the embolus. Diuretics are beneficial in patients with pleural effusion and heart failure. Endothelin receptor antagonists are used in the treatment of pulmonary hypertension, because they reduce pulmonary arterial pressure and pulmonary vascular resistance. Nonsteroidal antiinflammatory agents are used in the treatment of pleurisy to reduce chest pain. Text Reference - p. 552

A patient with hypoxemia, sudden alterations in mental status, chest pain, and hemoptysis has a serum troponin level of 2.08 ng/mL and B type natriuretic peptide of 600 pg/mL. Which treatment is useful to control this patient's condition? 1 Diuretics 2 Anticoagulants 3 Endothelin receptor antagonists 4 Nonsteroidal antiinflammatory agents

3 Carboplatin is a chemotherapeutic agent used to treat lung cancer. Erlotinib, crizotinib, and bevacizumab are drugs used for targeted therapy. Erlotinib blocks the signal for growth in the cancer cells. Crizotinib is used to treat abnormal anaplastic lymphoma kinase gene. Bevacizumab inhibits the growth of new blood vessels. Text Reference - p. 539

A patient with lung cancer is being scheduled for chemotherapy. About what medication will the nurse educate the patient that is used for treatment? 1 Erlotinib 2 Crizotinib 3 Carboplatin 4 Bevacizumab

4 Pericardial effusion is seen in patients with mediastinal involvement. Dyspnea, dysphagia, and pleural effusion are general symptoms of lung cancer, which may not be particularly associated with mediastinal involvement. Text Reference - p. 538

A patient with lung cancer is suspected to have mediastinal involvement. For what clinical manifestation does the nurse assess in this patient? 1 Dyspnea 2 Dysphagia 3 Pleural effusion 4 Pericardial effusion

1, 2 Stereotactic body radiotherapy is a radiation therapy that treats lung cancer by reducing the tumor cells. The treatment is provided in an outpatient setting for one to three days. The patient will have side effects such as skin irritation and anorexia. Because this radiotherapy is performed in an outpatient setting, the patient will not be admitted for two days in the hospital after the treatment. In stereotactic body radiotherapy, the higher dose of radiation will target the tumor cells and only small part of the healthy lung is exposed. Airway stenting is a technique that alleviates a patient's dyspea, cough, or respiratory insufficiency. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 539

A patient with lung cancer is undergoing stereotactic body radiotherapy. What information should the nurse give to the patient before performing the test? Select all that apply. 1 "You will undergo this treatment for one to three days." 2 "You will have skin irritation and anorexia for a few days." 3 "You will have to stay in the hospital for two days after treatment." 4 "You will receive high dose of radiation for the whole healthy lung along with the tumor." 5 "You will have relief from dyspea, cough, or respiratory insufficiency after this procedure."

2, 4, 5 To ensure complete recovery after pneumonia, the patient should be advised to rest, avoid alcohol and smoking, and take every dose of the prescribed antibiotic. The patient should not resume work if feeling fatigued and should be encouraged to drink plenty of fluids during the recovery period. Test-Taking Tip: The presence of absolute words and phrases can also help you determine the correct answer to a multiple-choice item. If answer choices contain an absolute (e.g., none, never, must, cannot), be very cautious. Remember that there are not many things in the world that are absolute, and in an area as complex as nursing, an absolute may be a reason to eliminate it from consideration as the best choice. This is only a guideline and should not be taken to be true 100% of the time; however, it can help you reduce the number of choices. Text Reference - p. 528

A patient with pneumonia is being treated at home and has reported fatigue to the nurse. What instructions should the nurse include when teaching the patient about care and recovery at home? Select all that apply. 1 Resume work to build strength. 2 Get adequate rest. 3 Restrict fluid intake. 4 Avoid alcohol and smoking. 5 Take every dose of the prescribed antibiotic

1 Body temperature of 100o F, shortness of breath, syncope, tachycardia, and chest pain may be the symptoms of pulmonary embolism. Fibrinolytic agents such as alteplase dissolve pulmonary emboli and the thrombi in deep veins in patients with right ventricular dysfunction. Bleomycin is an agent that is used for pleurodesis to clear pleural spaces. Epospostenol is a prostacyclin analog that promotes pulmonary vasodilation in the patient with pulmonary hypertension. Methotrexate is an immunosuppressant that may be used to control symptoms of idiopathic pulmonary fibrosis. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. Text Reference - p. 553

A patient with right ventricular dysfunction has a body temperature of 100o F, shortness of breath, syncope, tachycardia, and chest pain. Which treatment would benefit this patient? 1 Alteplase 2 Bleomycin 3 Epopostenol 4 Methotrexate

1 Body temperature of 99o F (low grade fever), fatigue, shortness of breath, and oxygen saturation of 80 percent may be signs of acute lung rejection. This occurs within five to ten days after surgery. Therefore, the patient should receive high doses of corticosteroids intravenously, for three days followed by oral prednisone. Iloprost nebulization is preferred for the patient with pulmonary hypertension for six to nine days. A three-to-six month oral regiment of warfarin for the patient with pulmonary embolism provides direct inhibition of thrombin. Subcutaneous administration of enoxaprin for three days is safer and more effective in treating the patient with pulmonary embolism than the use of oral anticoagulants. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 556

A patient with single lung transplantation has a body temperature of 99o F, fatigue, shortness of breath, and an oxygen saturation level of 80 percent. Which treatment may comfort this patient? 1 Intravenous prednisone for three days 2 Inhale iloprost six to nine times per day 3 Oral administration of warfarin for three to six months 4 Subcutaneous administration of enoxaprin for three days

3 Because most chemotherapeutic agents do not cross the blood-brain barrier, the patient might be at risk for cerebral metastasis even after systemic treatment with chemotherapy. Therefore, the patient should receive prophylactic cranial radiation. Photodynamic therapy can be used to treat very early stages of lung cancer. Radiofrequency ablation is used to treat non-small cell lung carcinoma. Steriotactic body radiotherapy is effective for patients with early stages of lung cancer who are not ideal candidates for surgery. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 539

A patient with small cell lung carcinoma who is suspected to be at a high risk for metastases has received chemotherapy treatment. For which treatment should the nurse prepare the patient after chemotherapy? 1 Photodynamic therapy 2 Radiofrequency ablation 3 Prophylactic cranial radiation 4 Steriotactic body radiotherapy

1 A patient with syncope, dyspnea, and a pulmonary artery pressure of 35 mm Hg after exercise may have pulmonary hypertension. Vasodilators, such as iloprost, may comfort the patient, but it should not be given when the systolic blood pressure is 70 mm Hg, because it may lead to orthostatic hypotension. Tracolimus and prednisolone are immunosuppressive agents that help prevent graft rejection in lung transplant patients. Methotrexate may be used to relieve the symptoms of idiopathic pulmonary fibrosis. Test-Taking Tip: The patient has a systolic blood pressure less than 85 mm Hg, which may result in hypotension. Select the correct medication that is not advised for this patient. Text Reference - p. 555

A patient with syncope and dyspnea has a systolic blood pressure of 70 mm Hg. The pulmonary artery pressure is 35 mm Hg after exercise. Which medication may worsen this patient's condition? 1 Iloprost 2 Tacrolimus 3 Prednisolone 4 Methotrexate

3 Airway stenting helps protect the airway wall against collapse or external compression, thereby delaying the extension of tumor into the airway lumen. The targeted therapy with crizotinib, a kinase inhibitor, helps reduce production of kinase protein produced by the ALK gene. Bronchoscopic laser therapy destroys tumor cells and causes thermal necrosis and shrinkage, which will clear the airway. Prophylactic radiation is a radiation therapy, which reduces the risk of cerebral metastasis in patients with lung cancer after receiving chemotherapy. Text Reference - p. 539

After assessing a patient with non-small cell lung cancer, the nurse finds that the patient has airway stenting. What outcome does the nurse expect for the patient after this treatment? 1 The patient will have a clear airway due to destruction of tumor. 2 The patient will have a decreased incidence of cerebral metastasis. 3 The patient will have a delay in extension of the tumor in the airway lumen. 4 The patient will have a reduced production of the kinase protein produced by the ALK gene.

4 Superior vena cava syndrome is a complication of cancer that is caused by thrombosis in the superior vena cava. This blockage of the superior vena cava results in edema of the neck and face. A pleural effusion is the presence of excess fluids around the lungs, which is one of the late signs of lung cancer. Cardiac tamponade is a complication of cancer that is associated with compression of the heart due to accumulation of fluid in the pericardial sac. Paraneoplastic syndrome is a complication of cancer that is associated with an excess release of hormones into the bloodstream. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 540

After the complete assessment of a patient with lung cancer, the nurse finds that the patient has edema of neck and face. Which complication does the nurse expect in the patient? 1 Pleural effusion 2 Cardiac tamponade 3 Paraneoplastic syndrome 4 Superior vena cava syndrom

1, 2, 4 Non-small-cell carcinoma is associated with cigarette smoking and exposure to environmental carcinogens, including asbestos and uranium. Chronic interstitial fibrosis is associated with the development of adenocarcinoma of the lung. Exposure to cancer-causing substances in the geographic area where the patient has lived for some time may be a risk, but not necessarily where the patient was born. Text Reference - p. 540

During admission of a patient diagnosed with non-small-cell lung carcinoma, the nurse questions the patient related to a history of which risk factors for this type of cancer? Select all that apply. 1 Asbestos exposure 2 Exposure to uranium 3 Chronic interstitial fibrosis 4 History of cigarette smoking 5 Geographic area in which the patient was born

2 The patient will have difficulty breathing after surgery due to the incision on the chest. Splinting the incision facilitates deep breathing. The nurse administers analgesics to reduce pain. An occlusive dressing is applied over the site of surgery to reduce air leakage. The nurse instructs the patient to perform range of motion exercise to increase perfusion or oxygen supply to the injured site. Text Reference - p. 548

How will splinting the incision with a pillow benefit a patient who underwent surgery to repair chest trauma? 1 It will reduce pain perception. 2 It will facilitate deep breathing. 3 It will reduce the risk of air leak. 4 It will increase perfusion at the site

3 If the dressing at the CT insertion site is loose, an air leak will occur and will need to be sealed. The water-seal chamber usually has 2 cm of water, but having more water will not contribute to an air leak, and it should not be drained from the CDS. No new drainage does not indicate an air leak, but may indicate the CT is no longer needed. If there is a pneumothorax, the chest tube should remove the air. Test-Taking Tip: The presence of absolute words and phrases can also help you determine the correct answer to a multiple-choice item. If answer choices contain an absolute (e.g., none, never, must, cannot), be very cautious. Remember that there are not many things in the world that are absolute, and in an area as complex as nursing, an absolute may be a reason to eliminate it from consideration as the best choice. This is only a guideline and should not be taken to be true 100% of the time; however, it can help you reduce the number of choices. Text Reference - p. 546

One week after a thoracotomy, a patient with chest tubes (CTs) to water-seal drainage has an air leak into the closed chest drainage system (CDS). Which patient assessment warrants follow-up nursing interventions? 1 Water-seal chamber has 5 cm of water 2 No new drainage in collection chamber 3 Chest tube with a loose-fitting dressing 4 Small pneumothorax at CT insertion site

1, 5 Empyema is a condition in which purulent fluid may accumulate in the pleural space during liver abscess. Chest x-ray of the patient may show the presence of fibrous fusion of the visceral and parietal pleurae. Empyema is generally treated by chest tube drainage and intrapleural fibrinolytic therapy to dissolve fibrous adhesions. Lung transplantation is performed in the patient with interstitial lung disease. Intercostal nerve blocks help to relieve pain in the patient with pleurisy. Diuretics and restriction of salt decrease the incidence of pleural effusion in the patient with heart failure. Test-Taking Tip: The patient has a fibrous fusion of pleurae. Identify the correct options by recollecting the treatment options for empyema, and by eliminating the incorrect answers. Text Reference - p. 550

The chest x-ray of a patient with a lung abscess reveals fibrous fusion of the pleurae. Which treatment strategy would benefit the patient? Select all that apply. 1 Chest tube drainage 2 Lung transplantation 3 Intercostal nerve blocks 4 Administration of diuretics 5 Intrapleural fibrinolytic therapy

1 In adenocarcinoma, the tumor is peripherally located and will have a moderate growth rate. A small cell carcinoma is a malignant lung cancer, which spreads through the lymphatics to the brain. In squamous cell carcinoma, the tumor is located in the central part of the lung and the patient may have a nonproductive cough and hemoptysis. Undifferentiated carcinoma has a rapid growth rate and is composed of anaplastic large cells, which arise on the bronchi. Test-Taking Tip: Having a thorough knowledge on different types of lung cancers helps in identifying the correct answer. Recall these findings to choose the correct answer. Text Reference - p. 537

The diagnostic studies of a patient with primary lung cancer indicate that the tumor is peripherally located and has a moderate growth rate. What does the nurse interpret from these findings? 1 The patient has adenocarcinoma. 2 The patient has small cell carcinoma. 3 The patient has squamous cell carcinoma. 4 The patient has undifferentiated carcinoma

2 Crizotinib is an anticancer drug that has anaplastic lymphoma kinase activity. Cisplatin is a platinum-containing compound that is used in combination with other chemotherapeutic agents to treat lung cancer. Etoposide is a cytotoxic anticancer drug that inhibits topoisomerase. Bevacizumab is a drug used to treat cancer by targeting the vascular endothelial growth factor. Text Reference - p. 539

The genetic studies of a patient with non-small cell lung cancer reveal the presence of anaplastic lymphoma kinase (ALK) genes. Which medication, administered by the nurse would have the best outcome for the patient? 1 Cisplatin 2 Crizotinib 3 Etoposide 4 Bevacizumab

2 The nurse should ensure that the sputum for culture and sensitivity has been sent to the laboratory before administering the antibiotic. It is important that the organisms be correctly identified (in the culture) before their numbers are affected by the antibiotic; the test also will determine whether the proper antibiotic has been prescribed (sensitivity testing). Vital signs and white blood cell count measurement can be assessed following the obtainment of sputum cultures. Timing of antibiotic administration should be based upon the institution's policy. Text Reference - p. 525

The health care provider has prescribed intravenous (IV) vancomycin for a patient with pneumonia. Which action should the nurse perform first? 1 Obtain a full set of vital signs 2 Obtain sputum cultures for sensitivity 3 Draw a blood specimen to evaluate the white blood cell count 4 Administer the antibiotic over at least 60 minutes

1 A patient's sputum is expected to convert to negative within three months of the beginning of treatment. If it does not, the patient is either not taking the medication or has drug-resistant organisms. Bilaterally clear breath sounds and a decrease in coughing are good indications that the patient is following the prescribed plan, but they are not as confirmatory as negative sputum cultures. Once a person has been exposed to the tuberculosis-causing organism, the Mantoux test will always elicit a positive result. Text Reference - p. 533

The nurse cares for a patient with a diagnosis of tuberculosis. Which assessment finding best indicates that the patient has been following the prescribed treatment plan? 1 Negative sputum cultures 2 Clear breath sounds bilaterally 3 Decrease in the number of coughing episodes 4 Conversion of the Mantoux test from positive to negative

2 Cyanosis, air hunger, distension of the neck vein, profuse diaphoresis, and an increase of intrathoracic pressure indicates tension pneumothorax in a patient with chest trauma. Tension pneumothorax is a complication associated with the presence of excess air in pleural thorax that cannot escape and is treated with needle decompression. Pericardiocentesis is helpful in aspirating fluid from the pleural space, which is more useful in cases of cardiac tamponade. Insertion of a chest tube with a flutter valve or a chest tube with drainage are techniques that help to drain air from the lung. However, these techniques are performed after needle decompression. Text Reference - p. 542

The nurse finds that a patient with chest trauma exhibits cyanosis, air hunger, distension of the neck vein, profuse diaphoresis, and an increase of intrathoracic pressure. What is the priority procedure in this situation? 1 Performing pericardiocentesis 2 Performing needle decompression 3 Insertion of chest tube with flutter valve 4 Insertion of chest tube with drainage system

3 Normal fluctuation of the water within the water-seal chamber is called tidaling. This up and down movement of water in concert with respiration reflects the intrapleural pressure changes during inspiration and expiration. Investigate any sudden cessation of tidaling, because this may signify an occluded chest tube. Monitoring the patient will occur simultaneously. The nurse could check all connections for a leak, but the most common cause is occlusion, so this would occur after checking for an occlusion. The drainage collector is likely already in a low position. Text Reference - p. 546

The nurse is assessing a patient who has a closed chest tube drainage system attached to a water-seal chamber. The nurse notes that the tidaling has stopped. What is the priority intervention by the nurse? 1 Continue to monitor the patient. 2 Check all connections for a leak in the system. 3 Investigate the chest tube for a possible occlusion. 4 Lower the drainage collector further from the chest.

1, 3, 5, 6 Active TB disease may manifest initially with constitutional symptoms such as fatigue, malaise, anorexia, unexplained weight loss, low-grade fevers, and night sweats. Dyspnea is a late symptom that may signify considerable pulmonary disease or a pleural effusion. Hemoptysis, which occurs in less than 10% of patients with TB, is also a late symptom. Text Reference - p. 529

The nurse is assessing a patient who was admitted from a nursing home with suspected tuberculosis (TB). Which of these are initial manifestations of tuberculosis? Select all that apply. 1 Anorexia 2 Dyspnea 3 Night sweats 4 Hemoptysis 5 Low-grade fever 6 Unexplained weight loss

4 A very high fluid level in the water chamber indicates high negative pressure in the patient with chest trauma. Therefore, the nurse should release the high negativity valve. Applying a clamp will stop the suction and decrease the risk of leakage but will not reduce negative pressure. Retaping the tube connections will reduce the leakage from the tube. The patient is on gravity drainage. Therefore, lowering the water seal column may cause complications for the patient. Test-Taking Tip: The patient is on chest-tube gravity drainage and the fluid level is very high in the chamber. Recall the effect it has on the chest wall while choosing the correct answer. You also need to concentrate on the key words. It will help eliminate the wrong options. Text Reference - p. 546

The nurse is assessing a patient with chest trauma who is on chest-tube gravity drainage. While assessing, the nurse finds that the fluid level in the chamber is very high. What is the best nursing intervention in this situation? 1 Applying the clamp to the tube 2 Retaping the tube connections 3 Lowering the water seal column 4 Releasing the high negativity valve

4 A lack of breath sounds over a portion of the lung fields indicates the presence of a pneumothorax. A spontaneous pneumothorax typically occurs because of the rupture of small blebs (air-filled blisters) located on the apex of the lung. These blebs can occur in healthy, young individuals, especially tall, thin males. Tension pneumothorax occurs when air enters the pleural space but cannot escape. The continued accumulation of air in the pleural space causes increasingly elevated intrapleural pressures. Tension pneumothorax can occur with mechanical ventilation and resuscitative efforts. Iatrogenic pneumothorax can occur because of laceration or puncture of the lung during medical procedures. Traumatic pneumothorax can occur from either penetrating (open) or nonpenetrating (closed) chest trauma. Text Reference - p. 542

The nurse is assessing a young male patient who came to the emergency department complaining of sudden shortness of breath. He has no other visible problems. The nurse notes that, upon auscultation, there are no breath sounds on the right upper lobe of the lung. The nurse suspects that the patient has which of these conditions? 1 Tension pneumothorax 2 Iatrogenic pneumothorax 3 Traumatic pneumothorax 4 Spontaneous pneumothorax

1 High pressure may cause tissue damage in Patient A, who is very frail. Therefore, a low pressure of -10 cm of H2O would be sufficient for the patient. Patient B is normal, so the pressure on chest drainage should be -20 cm of H2O. Patient C requires evacuation of pleural thorax. Therefore, the Patient C requires high-pressure drainage such as -30 to -40 cm of H2O. Patient D has pneumothorax, so the patient will require high pressure such as -30 to -40 cm of H2O to evacuate the pleural space. Test-Taking Tip: Chart/exhibit items present a situation and ask a question. A variety of objective and subjective information is presented about the patient in formats such as the medical record (e.g., laboratory test results, results of diagnostic procedures, progress notes, health care provider orders, medication administration record, and health history), physical assessment data, and assistant/patient interactions. After analyzing the information presented, the test taker answers the question. These questions usually reflect the analyzing level of cognitive thinking. In a clinical exam, you may be expected to select instruments, arrange instruments, and/or perform some other task. Acquaint yourself with the physical facility. If the required procedures are not clear to you, ask for clarification. Text Reference - p. 547

The nurse is assessing different patients who are undergoing the process of chest drainage using a chest drainage system. Which patient will require -10 cm H2O? 1. Patient A 2. Patient B 3. Patient C 4. Patient D

3, 4, 6 Cytomegalovirus (CMV) is the most common opportunistic infection. Because acute rejection is common, higher levels of immunosuppressive therapy than what other organ recipients receive are given. Diagnosis of rejection is confirmed by transtracheal biopsy. Immunosuppressive therapy is usually a three-drug regimen and acute rejection can occur in the first 5 to 10 postoperative days. If acute rejection is diagnosed, then high doses of corticosteroids are given for three days, followed by high doses of oral prednisone. If this does not work and rejection occurs, then antilymphocytic therapy may be useful. Bacterial pneumonia is the most common postoperative infection. Text Reference - p. 556

The nurse is caring for a patient who had a recent lung transplant. The nurse knows which of the following? Select all that apply. 1 Acute rejection can occur two to three weeks after surgery. 2 Immunosupressive therapy is usually a two-drug regimen. 3 Accurate diagnosis of rejection is by transtracheal biopsy. 4 Cytomegalovirus (CMV) pneumonia is the most common opportunistic infection. 5 During the first year, viral pneumonia is the most common postoperative infection. 6 Lung transplant recipients usually receive higher levels of immunosuppressive therapy than other organ recipients.

1, 2, 3 Although the nasogastric tubes are small, there is an increased risk for aspiration pneumonia; to prevent it, the head of the bed should be elevated to 30 to 45 degrees, gastric residual volumes should be monitored, and the patient should be made to sit upright for all meals. Lowering the head of the bed and reclining while eating are not advisable, because these positions can increase the risk of aspiration. Text Reference - p. 527

The nurse is caring for a patient who has a nasogastric tube. What actions should the nurse perform to prevent aspiration in this patient? Select all that apply. 1 Elevate the head of the bed 30 to 45 degrees. 2 Monitor gastric residual volumes. 3 Encourage the patient to sit upright for all meals. 4 Lower the head of the bed to 10 degrees. 5 Feed the patient in a reclined position.

4 Range of motion exercises performed on the affected upper extremity will prevent edema and encourage circulation to the lung space to promote healing. A patient who has had a pneumonectomy may have a clamped chest tube postoperatively, so there will not be any drainage. Fluid will gradually fill the space where the lung has been removed. Position the patient on operative side to facilitate expansion of remaining lung. There will not be lung sounds on the operative side, because the entire lung has been removed. Text Reference - p. 548

The nurse is caring for a patient who has had a left pneumonectomy. An appropriate nursing intervention for a patient postpneumonectomy is: 1 Monitoring chest tube drainage and functioning 2 Positioning the patient on the nonoperative side 3 Auscultating frequently for lung sounds on the operative side 4 Encouraging range-of-motion exercises on the affected upper extremity

4 Absence of bubbles indicates that the patient may have a high pleural air leak. Excessive bubbling in the water-seal chamber results in evaporation from the chamber. Tidaling in the water seal chamber indicates that the drainage system is blocked or the patient will have lung expansion due to suction. Text Reference - p. 546

The nurse is caring for a patient who is on a chest drainage tube with wet suction system. The nurse finds that the suction control chamber has no bubbles. What does the nurse expect from this finding? 1 The drainage system is blocked. 2 The chamber is getting evaporated. 3 The patient will have lung expansion. 4 The patient has a high pleural air leak.

4 Patients are classified using the New York Heart Association functional classification. IAPH occurs more often in females than in males. The time between onset of symptoms and diagnosis is about two years and usually by the time the patient becomes symptomatic, the disease is in the advanced stages. IAPH increases the work of the right ventricle and causes right-ventricular hypertrophy (cor pulmonale). Test-Taking Tip: Being prepared reduces your stress or tension level and helps you maintain a positive attitude. Text Reference - p. 554

The nurse is caring for a patient with a diagnosis of idiopathic pulmonary arterial hypertension (IAPH). The nurse knows that: 1 IAPH occurs more often in males than females. 2 The mean diagnosis time between onset of symptoms and diagnosis is 5 to 10 years. 3 IAPH increases the work of the left ventricle and causes left-ventricular hypertrophy. 4 Functional classification of IAPH is measured by using the New York Heart Association Scale.

2 Purulent sputum is dark brown, foul smelling, and foul tasting. Hemoptysis is common. Anaerobic organisms are the primary cause of lung abscesses and clinical manifestations occur slowly over a period of weeks to months. Physical examination shows dullness and decreased breath sounds. Test-Taking Tip: Do not panic while taking an exam! Panic will only increase your anxiety. Stop for a moment, close your eyes, take a few deep breaths, and resume review of the question. Text Reference - p. 534

The nurse is caring for a patient with a diagnosis of lung abscess. The nurse knows that: 1 Hemoptysis rarely occurs. 2 Purulent sputum often is dark brown 3 Physical examination reveals hyperresonance and fremitus 4 Clinical manifestations related to anaerobic organisms usually occur more acutely over a period of a few days

4 Subcutaneous administration of low-molecular-weight heparin has been found to be safer and more effective than use of unfractionated heparin. It is also the recommended choice of treatment for patients with non-massive PE. Criteria for fibrinolytic therapy in PE include hemodynamic instability and right ventricular dysfunction. Fibrinolytic therapy dissolves pulmonary embolisms and the source of the thrombus. Low-molecular-weight heparin is becoming more common for non-massive pulmonary embolism. Warfarin should be initiated within the first 24 hours s of heparinization and is typically administered for three to six months. Warfarin therapy is the standard treatment for non-massive PE. Test-Taking Tip: Key words or phrases in the stem of the question such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. As in life, no real absolutes exist in nursing; however, every rule has its exceptions, so answer with care. Text Reference - p. 579

The nurse is caring for a patient with a non-massive pulmonary embolism (PE). What is the best standard for treatment? 1 Tissue plasminogen activator 2 Alteplase 3 Warfarin 4 Enoxaparin

3 A patient with right ventricular hypertrophy, chest pain, dizziness, and an oxygen saturation level of 80 percent may have pulmonary hypertension. Therefore, the patient must be treated with trepostinil because it acts by dilating the systemic and pulmonary arteries. Warfarin is administered in a patient with pulmonary embolism. Morphine helps relieve the patient's chest pain, but will not completely control the patient's condition. Cyclosporine is an immunosuppressant that may provide comfort for the patient with idiopathic pulmonary fibrosis. Text Reference - p. 554

The nurse is caring for a patient with chest pain, dizziness, and an oxygen saturation level of 80 percent. The chest x-ray of the patient reveals right ventricular hypertrophy. Which medication may be beneficial to this patient? 1 Warfarin 2 Morphine 3 Trepostinil 4 Cyclosporine

2 A patient with dyspnea, cough, and pain upon inhalation associated with decreased movement of the chest and breath sounds on the affected side upon auscultation may have pleural effusion. Pleural effusion may be controlled by draining the accumulated fluid in the pleural space and may not require lung transplantation for the patient. Chemical pleurodesis is a chest tube drainage method that helps to clear the pleural space and prevent further accumulation of effusion fluid. Pain during pleurisy can be reduced with intercostal nerve blocs. . A median sternotomy incision is used for heart-lung transplantation in a patient with end-stage lung disease. Text Reference - p. 550

The nurse is caring for a patient with dyspnea, cough, and pain upon inhalation. Physical examination shows decreased movement of the chest on the affected side and decreased breath sounds upon auscultation. Which treatment strategy does the nurse anticipate will benefit the patient? 1 Lung transplantation 2 Chemical pleurodesis 3 Intercostal nerve block 4 Median sternotomy incision

2 Inflammation associated with sharp and abrupt pain upon inspiration indicates pleurisy. This occurs due to friction rub of the inflamed pleura during inspiration. Analgesics are helpful to relieve pain, but the nurse has to teach a patient with pleurisy to lay on the affected side or to splint the rib cage to provide comfort. A sodium-rich diet is indicated in the patient with cor pulmonale and pulmonary hypertension to reduce the incidence of heart failure. Deep inspirations or breathing exercises for 30 minutes regularly may trigger the patient's condition and should be avoided.

The nurse is caring for a patient with inflammation associated with sharp and abrupt pain upon inspiration. Which action of the nurse would be beneficial to the patient? 1 Restricting sodium in the patient's diet 2 Teaching the patient to splint the ribs while coughing 3 Encouraging the patient to take deep and long breaths 4 Encouraging the patient to exercise regularly for 30 minutes

4 Radiofrequency ablation is a therapy that uses an electric current to destroy tumor cells that provides effective treatment to the patient with lung cancer. Patients who cannot undergo surgery can have radiofrequency ablation therapy as an alternative. Airway stenting is used in combination with other techniques to relieve dyspnea, cough, or respiratory distress. Chemotherapy is used as an adjuvant to surgery to treat non-small cell lung cancer. Photodynamic therapy is used to treat a very early stage of lung cancer that is confined to the outer layers of the airways. Text Reference - p. 539

The nurse is caring for an older frail adult patient with stage II non-small cell lung cancer who may not be a candidate for a surgical procedure. About what alternative should the nurse educate the patient? 1 Airway stenting 2 Chemotherapy 3 Photodynamic therapy 4 Radiofrequency ablation

1, 2, 3 Pregnancy, pelvic surgery, and immobility are major risk factors associated with a pulmonary embolism. Risk factors among many for PE include immobility, pelvic surgery, pregnancy, oral contraceptives and hormone therapy. Herbal therapy is incorrect because herbal therapy is not associated with the development of a pulmonary embolism. Text Reference - p. 578

The nurse is caring for the patient with a pulmonary embolism. Which factor(s) are associated with a pulmonary embolism (PE)? Select all that apply. 1 Pregnancy 2 Pelvic surgery 3 Immobility 4 Herbal therapy

1, 2, 3 Vasodilators, diuretics, and anticoagulants are correct because they are included in drug treatments for pulmonary hypertension. Vasodilators are especially important in the treatment of pulmonary hypertension, because they will aid in reducing the right ventricular workload by dilating pulmonary vessels. Diuretics decrease plasma volume and thereby reduce myocardial workload. Anticoagulants also are used, especially if the case is severe, because they work to prevent in situ thrombus formation and venous thrombosis. Warfarin would be given to keep the international normalized ratio (INR) in the 2 to 3 range. Thrombolytic therapy is not an appropriate drug treatment and would be used if the condition caused right ventricle hypertrophy, resulting in cor pulmonale. Text Reference - p. 582

The nurse is caring for the patient with pulmonary hypertension. Which treatment(s) are appropriate? Select all that apply. 1 Vasodilators 2 Diuretics 3 Anticoagulants 4 Thrombolytics

2 A patient on thoracentesis undergoes aspiration of the excess intrapleural fluid from the intercostal area. Usually 1000 to 1200 mL of fluid is drained at once. Rapid removal of large amounts of fluid may result in respiratory distress, hypotension, hypoxemia, or pulmonary edema. Cor pulmonale is a condition in which the right ventricle gets enlarged due to respiratory disorders. Pulmonary hypertension results in decreased blood flow to the lungs with increased pulmonary artery pressure to 20 to 30 mm Hg. Interstitial lung disease refers to the diffuse parenchymal disorder in which the tissues between the air sacs are inflamed or scarred. Text Reference - p. 550

The nurse is performing aspiration at the intercostal area on a patient with pleural effusion. Which condition may be observed in a patient after rapid draining of 1500 mL of fluid? 1 Cor pulmonale 2 Respiratory distress 3 Pulmonary hypertension 4 Diffuse parenchymal disorder

3 The nurse asks the patient about chest, shoulder, arm, or bone pain while assessing the cognitive-perceptual health pattern in a patient with lung cancer. The nurse questions a patient's smoking habit while assessing the health perception-health management pattern. The nurse asks the patient about nausea, vomiting, and dysphagia while assessing the nutritional-metabolic pattern. While assessing the patient's activity-exercise health pattern, the nurse asks about persistent cough, fatigue, and dyspnea either at rest or with exertion. Text Reference - p. 540

The nurse is performing complete assessment of a patient who has lung cancer. Which question does the nurse ask in the interview while assessing the cognitive-perceptual pattern in the patient? 1 "Do you have a nauseous feeling?" 2 "Do you have a habit of smoking?" 3 "Do you have pain in the shoulder and arm?" 4 "Do you have persistent cough and fatigue?"

1 VATS is a minimally invasive surgical approach to the chest cavity to diagnose and treat diseases of the pleura, pulmonary masses and nodules, mediastinal masses, and interstitial lung disease. VATS involves a real-time two-dimensional video. VATS is a good option for debilitated patients and those with limited respiratory reserve. It is being used also for patients with chest trauma. Test-Taking Tip: The night before the examination you may wish to review some key concepts that you believe need additional time, but then relax and get a good night's sleep. Remember to set your alarm, allowing yourself plenty of time to dress comfortably (preferably in layers, depending on the weather), have a good breakfast, and arrive at the testing site at least 15 to 30 minutes early. Text Reference - p. 548

The nurse is preparing a patient for video-assisted thoracotomy surgery (VATS). The nurse knows that this type of procedure: 1 Is a minimally invasive surgical approach 2 Provides a real-time one-dimensional video 3 Is contraindicated in patients with chest trauma 4 Can only be used for patients in previously good health

4 A patient who has a smoking history of 30 packs per year would be at risk of lung cancer. Therefore, low-dose spiral computed tomography scanning is recommended. Patients who have a history of lung cancer or are on home oxygen therapy are not ideal candidates for low-dose spiral computed tomography. A patient with a history of alcohol intake does not require low-dose spiral computed tomography, because alcohol does not increase the risk of lung cancer. Text Reference - p. 538

The nurse is preparing several patients for diagnostic testing. Which patient is suitable to undergo screening with low-dose spiral computed tomography? 1 A patient who has lung cancer. 2 A patient who is on home oxygen therapy. 3 A patient who has a history of alcohol intake. 4 A patient who has a smoking history of 30 packs per year.

1 Age of smoking onset is the directly related risk of lung cancer. Use of filtered cigarettes, number of cigarettes per day, and prolonged exposure to nickel may not be directly related. Text Reference - p. 536

The nurse is providing a community program about lung cancer. What risk factor should the nurse be sure to include when discussing this topic? 1 Age of smoking onset 2 Use of filtered cigarettes 3 Prolonged exposure to nickel 4 Number of cigarettes smoked per day

1 A mucous gland adenoma is a benign tumor that arises in the bronchi. Mesotheliomas may be either benign or malignant and develop in the visceral pleura. Hamartomas are benign tumors composed of fibrous tissue. A secondary metastasis is a malignancy associated with the spread of a tumor via the capillaries to the lungs. Text Reference - p. 541

The nurse is reviewing a chest x-ray for a client diagnosed with a mucous gland adenoma. Where does the nurse expect to find the tumor? 1 In the bronchi 2 In visceral pleura 3 In the fibrous tissue 4 In the capillaries, spreading to the lungs

4 Amphotericin B remains the standard therapy for treating serious systemic fungal infections. These infections are not transmitted from person to person, and the patient does not have to be placed in isolation. Opportunistic fungal infections occur in immunocompromised patients (e.g., those being treated with corticosteroids, chemotherapy, and immunosuppressive drugs) and in patients with human immunodeficiency virus (HIV) and cystic fibrosis. Fungal infections are acquired by inhalation of spores. Text Reference - p. 534

The nurse is reviewing the care of a patient with a pulmonary fungal infection. Which of these statements is true? 1 The patient will be placed on droplet isolation. 2 Opportunistic fungal infections occur in otherwise healthy people. 3 Pulmonary fungal infections are transmitted from person to person. 4 Amphotericin B is the standard therapy for treating serious systemic fungal infections.

4 Depending on the source used, the normal white blood cell count is 4000 to 11,000/mm3or 5000 to 10,000/mm3. Because cefuroxime is a cephalosporin-type antibiotic, a white blood cell count within the normal range indicates resolution of infection. The BUN, platelet count, and sodium level are also normal; however, these results do not relate to antibiotic therapy. Text Reference - p. 525

The nurse is reviewing the laboratory reports for the patient receiving cefuroxime. The nurse determines that the medication is having the intended effect by noting which laboratory result? 1 Blood urea nitrogen (BUN) 8 mmol/L 2 Platelets 175,000 per µL 3 Sodium 138 mEq/L 4 White blood cell count 4500/mm

1, 2, 3 Impaired gas exchange is evidenced by low oxygen saturation and elevated PaCO2 with absent breath sounds. Yellow mucus would indicate clearance of secretions. An increased respiratory rate does not imply impaired gas exchange. Text Reference - p. 525

The nurse makes a nursing diagnosis of "impaired gas exchange" for a patient with pneumonia based upon which physical-assessment findings? Select all that apply. 1 SpO2 of 85% 2 PaO2 of 65 mm Hg 3 Absent breath sounds in right lung lobes 4 Presence of thick yellow mucus 5 Respiratory rate 24 breaths/minute

4 Thoracentesis involves the insertion of a large-bore needle into the pleural space to relieve an abnormal accumulation of fluid in the pleural space. The procedure can significantly relieve symptoms related to this fluid accumulation, such as shortness of breath and discomfort. Thoracentesis cannot reveal the stage of lung cancer or permit direct inspection and examination of the pleural space. It may provide a pleural fluid specimen but not a pleural tissue specimen. Text Reference - p. 550

The nurse provides preprocedure teaching for a patient who is scheduled for bedside thoracentesis. What does the nurse explain to be the primary purpose of thoracentesis? 1 Determining the stage of a lung tumor 2 Directly inspecting and examining the pleural space 3 Obtaining a specimen of pleural tissue for evaluation 4 Relieving an abnormal accumulation of fluid in the pleural space

2 A patient who has a malignant tumor that has spread to the mediastinum will have cardiac complications. Therefore, pericardial effusion indicates that the patient has a tumor in the mediastinum. Dysphagia, superior vena cava obstruction, and unilateral paralysis of the diaphragm characterize intrathoracic spread of the malignancy. Text Reference - p. 538

The nurse who is caring for a patient with lung cancer anticipates that the tumor has spread to the mediastinum. Which finding helps the nurse to reach this conclusion? 1 Presence of dysphagia 2 Presence of pericardial effusion 3 Obstruction of the superior vena cava 4 Unilateral paralysis of the diaphragm

3 Lymphatic flow of 3000 mL/day in the patient with chylothorax indicates abnormal flow of lymph. Pleurodesis is a surgical procedure that produces adhesions between the parietal and visceral pleura and reduces the risk of pneumothorax recurrence. Pleurodesis is usually done with a chemical sclerosing agent, such as doxycycline. Octreotide is a hormone-like drug that acts as a vasoconstrictor and reduces lymphatic flow; however, this medication is not used after pleurodesis. Prednisone is a corticosteroid used to reduce progression of chronic pulmonary fibrosis. Cyclosporine is an immunosuppressive drug that treats pulmonary fibrosis. Text Reference - p. 543

The nurse, while examining a patient with chylothorax, finds that the patient has lymphatic flow of 3000 mL/day. The primary health care provider prescribes pleurodesis for the patient. Which other medication does the nurse expect in the patient's prescription? 1 Octreotide 2 Prednisone 3 Doxycycline 4 Cyclosporine

3 Acute bronchitis is usually self-limiting and treatment for acute bronchitis is supportive. Chest x-rays will differentiate acute bronchitis form pneumonia. In bronchitis, there is not consolidation or infiltrates on x-ray as there is in pneumonia. Text Reference - p. 549

The patient has acute bronchitis. What is the most important factor for the nurse to consider for this patient? 1 Clinical assessment finding of egophony 2 Presence of tactile fremitus 3 Therapy is mainly supportive 4 Abnormal chest x-ray

3 The patient with an opportunistic fungal infection does not need to be isolated because C. albicans is not transmitted from person to person. This immunocompromised patient will be likely to have a serious infection so it will be treated with intravenous amphotericin B. The effectiveness of the therapy can be monitored with fungal serology titers. Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be very helpful, because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur. Text Reference - p. 534

The patient with human immunodeficiency virus (HIV) has been diagnosed with Candida albicans, an opportunistic infection. The nurse knows the patient needs more teaching when the patient says, 1 "I will be given amphotericin B to treat the fungus." 2 "I got this fungus because I am immunocompromised." 3 "I need to be isolated from my family and friends so they won't get it." 4 "The effectiveness of my therapy can be monitored with fungal serology titers."

2 Aspiration of the intrapleural fluid is thoracentesis, which is used for diagnostic and therapeutic purposes. The nurse should aspire about 100 to 1200 mL of fluid at once; excess fluid drainage may lead to hypotension, hypovolemia, and pulmonary edema. The nurse should monitor vital signs, pulse oximetry (oxygen saturation), and signs for respiratory distress during and after the procedure. The patient is moved to the edge of the bed and is asked to lean forward onto a table. The nurse then applies a local anesthetic and injects the thoracentesis needle into the intercostal area to perform thoracentesis. Text Reference - p. 550

The registered nurse is evaluating the student nurse performing aspiration of intrapleural fluid. Which action performed by the student nurse indicates the need for correction? 1 Monitoring vital signs and oxygen saturation 2 Aspirating 1500 mL of pleural fluid at one time 3 Making the patient lean forward onto a table 4 Injecting a local anesthetic at the intercostal are

2 Carboplatin is a chemotherapeutic agent that inhibits DNA synthesis; this drug does not target the endothelial growth factor. Erlotinib inhibits an enzyme called tyrosine kinase, which is associated with epidermal growth factor receptor. Bevacizumab targets the vascular endothelial growth factor and inhibits the growth of new blood vessels. Crizotinib directly inhibits the kinase protein produced by an abnormal anaplastic lymphoma kinase (ALK) gene and helps reduce the growth of cancer cells. Text Reference - p. 539

The registered nurse is teaching a student nurse about targeted therapy for lung cancer. Which statement made by the student nurse indicates a need for further teaching? 1 "Erlotinib inhibits tyrosine kinase." 2 "Carboplatin targets the endothelial growth factor." 3 "Bevacizumab inhibits the growth of new blood vessels." 4 "Crizotinib acts on the anaplastic lymphoma kinase (ALK) gene."

4 Although several interventions may help the patient expectorate mucus, the highest priority should be on increasing fluid intake, which will liquefy the secretions so that the patient can expectorate them more easily. Humidifying the oxygen also is helpful, but is not the primary intervention. Teaching the patient to splint the affected area also may be helpful in decreasing discomfort, but does not assist in expectoration of thick secretions. Text Reference - p. 528

What is the priority nursing intervention in helping a patient expectorate thick lung secretions? 1 Humidify the oxygen as able 2 Administer cough suppressant q4hr 3 Teach patient to splint the affected area 4 Increase fluid intake to 3 L/day if tolerated

1 Decortication is a surgical procedure that is used in the patient with empyema when the intrapleural fibrinolytic therapy is unsuccessful. It helps remove the thick and fibrous pleural peel that restricts the expansion of the lungs during inspiration. Fluid is aspirated with a syringe or tubing into a sterile container while performing thoracentesis. A patient with pulmonary embolism is placed in a semi-Flower's position to facilitate breathing. An incision on the side of the chest is made in the patient with single-lung transplantation that involves ventilation of the opposite lung while the other is being replaced. Text Reference - p. 550

The registered nurse is teaching the student nurse about the decortication procedure. Which statement made by the student nurse indicates effective learning? 1 "Remove a pleural peel that is thick and fibrous surgically." 2 "Fluid is aspirated with syringe or tubing into a sterile container." 3 "Place the patient in semi-Fowler's position to facilitate breathing." 4 "An incision is made on the side of the chest and the opposite lung is ventilated."

1, 2, 5 Maintaining adequate fluid intake liquefies secretions, allowing easier expectoration. The nurse should instruct the patient to splint the chest while coughing. This will reduce discomfort and allow for a more effective cough. Coughing at the end of exhalation promotes a more effective cough. The patient should be positioned in an upright sitting position (high-Fowler's) with head slightly flexed. Text Reference - p. 527

To promote airway clearance in a patient with pneumonia, what should the nurse instruct the patient to do? Select all that apply. 1 Maintain adequate fluid intake 2 Splint the chest when coughing 3 Maintain a 30-degree elevation 4 Maintain a semi-Fowler's position 5 Instruct patient to cough at end of exhalation

1 Stage IV lung cancer is characterized by distant metastasis, whereby the tumor spreads to distant organs. A tumor that is 5 cm in size can be seen in stage I B and stage II A. In stage III A, the tumor spreads to the regional lymph nodes and nearby structures such as the pleura and pericardium. Test-Taking Tip: Do not spend too much time on one question, because it can compromise your overall performance. There is no deduction for incorrect answers, so you are not penalized for guessing. You cannot leave an answer blank; therefore, guess. Go for it! Remember: You do not have to get all the questions correct to pass. Text Reference - p. 538

What diagnostic information does a nurse relate to a patient with stage IV lung cancer? 1 Presence of distant metastasis 2 Presence of a tumor which is 5 cm in size 3 Tumor spreading to the regional lymph nodes 4 Tumor spreading to the pleura and pericardium

2 The patient with chest trauma is in need of chest tube drainage. Excess bubbling in the water seal chamber may cause air leakage from the water seal chamber and may result in bronchopleural leak. Lung expansion in the water seal chamber is indicated by tidaling. An absence of bubbles in the chamber may indicate a large pleural air leak. The presence of inflammation, erythema at the site, and an increase in white blood cell count indicates infection. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Text Reference - p. 546

What does the nurse interpret from finding excessive bubbling in the water seal chamber while monitoring a patient who is on chest tube drainage? 1 The patient may have lung expansion. 2 The patient may have a bronchopleural leak. 3 The patient may have a large pleural air leak. 4 The patient may have an infection at the drainage site.

3 While removing the chest tube, the nurse instructs the patient to perform the Valsalva maneuver because it eases the process of removal. Therefore, the nurse instructs the patient to hold his or her breath or bear down. Sleeping in a side-lying position will reduce lung expansion. Therefore, the patient's condition may be aggravated. The nurse instructs the patient to elevate the leg when he or she has risk of thromboembolism. The nurse does not instruct the patient to drink juice because it may result in nausea. Text Reference - p. 547

What instruction does the nurse give the patient while removing the chest tube? 1 "You should sleep in a side-lying position." 2 "You should sleep with your leg elevated." 3 "You should hold your breath or bear down." 4 "You should drink juice before the procedure."

2, 5 The semi-Fowler's position facilitates lung expansion, so the patient will be able to breathe easily. The nurse tells the patient that he or she may sleep on the injured side when breathing is comfortable. Bathing will not complicate the improved condition of cervical spine injury. Applying a binder will reduce chest expansion, so the nurse does not instruct the patient to apply a binder over his or her chest. There is no need to wear the cervical collar throughout the day, because the cervical spine injury has improved. Text Reference - p. 541

What instructions would the nurse give to the patient with a cervical spine injury who, during follow-up visits, shows improvement? Select all that apply. 1 "You should avoid bathing for few days." 2 "You may sleep in a semi-Fowler's position." 3 "You should apply a binder over your chest." 4 "You should wear a cervical collar throughout the day." 5 "You may sleep on the injured side if your breathing is comfortable."

2 The characteristic feature of stage III A lung cancer is a tumor that spreads to the nearby structures, such as the pleura. The heart is involved in stage III B lung cancer. Bronchus involvement is associated with stage II B lung cancer. Contralateral lymph nodes are involved in stage III B lung cancer. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses. Text Reference - p. 538

What is the characteristic feature of stage III A lung cancer? 1 Tumor involving the heart 2 Tumor involving the pleura 3 Tumor involving the bronchus 4 Tumor involving the contralateral lymph nodes

1 Atelectasis is a complete or partial closure of the lungs leading to a reduced exchange of gases that can cause intrapulmonary restrictive disease. Kyphoscoliosis, chest wall trauma, and Pickwickian syndrome cause extrapulmonary restrictive disease, in which the lung tissue is normal. Text Reference - p. 549

Which condition may lead to intrapulmonary restrictive disease? 1 Atelectasis 2 Kyphoscoliosis 3 Chest wall trauma 4 Pickwickian syndrome

3 Therapeutic positioning identifies the best position for the patient, thus assuring stable oxygenation status. Research indicates that positioning the patient with the unaffected lung (good lung) dependent best promotes oxygenation in patients with unilateral lung disease. For bilateral lung disease, the right lung down has best ventilation and perfusion. Increasing fluid intake and performing postural drainage will facilitate airway clearance, but positioning is most appropriate to enhance oxygenation. Text Reference - p. 540

What nursing intervention is most appropriate to enhance oxygenation in a patient with unilateral malignant lung disease? 1 Positioning patient on right side 2 Maintaining adequate fluid intake 3 Positioning patient with "good lung" down 4 Performing postural drainage every four hours

4 The drainage system should be properly checked to lessen the risk of complications. If the drainage system is found to be broken, then the distal end of the chest tubing connection should be placed in a sterile water container at a 2-cm level as an emergency water seal. Milking and stripping the drainage tubes are done only when there is an order from the physician. The collection chamber should never be emptied but should be replaced. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Text Reference - p. 546

What will be the immediate nursing action if the nurse, while caring for a patient with chest trauma, finds that the drainage system in the patient is broken? 1 Milking the drainage tubes 2 Stripping the drainage tubes 3 Emptying the collection chamber 4 Placing the chest tubing in a sterile water container

4 Intrathoracic spread of a malignant tumor will result in unilateral paralysis of the diaphragm. A patient with stage III A lung cancer will have a tumor with regional lymph node involvement. A patient with a malignant tumor that has spread to the mediastinum will have cardiac tamponade and pleural effusion. If the tumor has spread to the laryngeal nerve, the patient may experience hoarseness. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. Text Reference - p. 538

When assessing a patient with lung cancer, the nurse finds that the patient has unilateral paralysis of the diaphragm. What does the nurse interpret from this finding? 1 The patient has a tumor with lymph node involvement. 2 The patient has a tumor with mediastinum involvement. 3 The patient has a tumor with laryngeal nerve involvement. 4 The patient has a tumor with intrathoracic region involvement.

1 Treatment for pertussis is antibiotics, usually macrolides (erythromycin, azithromycin), to minimize symptoms and prevent spread of the disease. Cough suppressants and antihistamines should not be used, because they are ineffective and may induce coughing episodes. Corticosteroids and bronchodilators are not useful in reducing symptoms. Text Reference - p. 522

When caring for a patient with pertussis, the nurse will prioritize 1 Administering antibiotic therapy 2 Having the patient use an antihistamine at night 3 Teaching the patient how to use a bronchodilator 4 Instructing the patient to use cough suppressants

1, 2, 3, 4 In order to prevent the spread of infection, patients with tuberculosis should be encouraged to cover the nose and mouth with tissues while coughing and sneezing, to throw used tissues in a paper bag and dispose of them with the trash, to carefully wash hands after handling sputum and soiled tissues, and to wear a standard isolation mask while moving out of their room. Increasing the frequency of prolonged visits to other parts of the hospital is not advisable, because it can increase the chances of infection spread; instead, such visits should be limited. Drinking plenty of water and maintaining erect posture have no effect on controlling infection. Text Reference - p. 533

When caring for a patient with tuberculosis, what measures should the nurse instruct the patient to take to avoid the spread of infection? Select all that apply. 1 Cover the nose and mouth with a tissue while coughing and sneezing. 2 Throw used tissues in a paper bag and dispose with the trash. 3 Carefully wash hands after handling sputum and soiled tissues. 4 Wear a standard isolation mask when outside the patient's room. 5 Get out of bed and move freely about the hospital to keep up strength. 6 Drink plenty of water and maintain an erect posture

2 Smoking decreases the mucociliary action in the tracheobronchial tree, resulting in impaired clearance of respiratory secretions and particles, chronic cough, and frequent respiratory infections. Cough reflex, reflex bronchoconstriction, and ability to filter particles from the air do not increase underlying respiratory defenses. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer. Text Reference - p. 536

When planning appropriate nursing interventions for a patient with metastatic lung cancer and a 60-pack-per-year history of cigarette smoking, the nurse recognizes that the smoking most likely has decreased the patient's underlying respiratory defenses because of impairment of: 1 Cough reflex 2 Mucociliary clearance 3 Reflex bronchoconstriction 4 Ability to filter particles from the air

4 Forcing fluids is a priority of care in patients with pneumonia. Fluids keep secretions liquefied and loose so they can be more easily raised and expectorated. Analgesics are important as is keeping the patient calm to decrease oxygen needs, but fluids, either IV or oral, are the first priority. Vital signs should be checked every four hours or more often as indicated. Text Reference - p. 528

When planning care for a patient with pneumonia, the nurse recognizes which intervention as the highest priority? 1 Administering analgesics as needed for pain 2 Keeping the patient in a calm and quiet environment 3 Routinely checking vital signs and oxygen saturation 4 Increasing fluids to 2 to 3 L/day unless contraindicated

3 IV antibiotics are used until the patient and x-ray show evidence of improvement. Then oral antibiotics are used for a prolonged period of time. Lobectomy surgery is needed only when reinfection of a large cavitary lesion occurs or to establish a diagnosis when there is evidence of a neoplasm or other underlying problem. Culture and sensitivity testing is done during the course of antibiotic therapy to ensure that the infecting organism is not becoming resistant to the antibiotic as well as at the completion of the antibiotic therapy. Text Reference - p. 534

When the patient is diagnosed with a lung abscess, what should the nurse teach the patient? 1 Lobectomy surgery usually is needed to drain the abscess. 2 Intravenous (IV) antibiotic therapy will be used for a prolonged period of time. 3 Oral antibiotics will be used when the patient and x-ray show evidence of improvement. 4 No further culture and sensitivity tests are needed if the patient takes the medication as prescribed.

1 The suction control chamber should not be open; a muffler should be provided to cover the suction control chamber to prevent rapid evaporation of water. The suction control system should show the presence of bubbling; the absence of bubbling indicates that there is no suction. Sterile water is to be added to the suction control chamber to replace water lost from evaporation. The suction tubing should be connected to the wall section after filling the suction control chamber to the ordered suction amount. Text Reference - p. 546

Which alteration to the suction control system in a wet suction system requires immediate correction? 1 The suction control chamber is open. 2 The suction control chamber shows bubbling. 3 The suction control chamber contains sterile water. 4 The suction tubing is connected to the wall section.

3 A typical physical examination finding for a patient with pneumonia is increased vocal fremitus on palpation. Other signs of pulmonary consolidation include bronchial breath sounds, egophony, and crackles in the affected area. With pleural effusion, there may be dullness to percussion over the affected area. Test-Taking Tip: Because few things in life are absolute without exceptions, avoid selecting answers that include words such as always, never, all, every, and none. Answers containing these key words are rarely correct. Text Reference - p. 524

Which clinical manifestation should the nurse expect to find during assessment of a patient admitted with pneumonia? 1 Hyperresonance on percussion 2 Vesicular breath sounds in all lobes 3 Increased vocal fremitus on palpation 4 Fine crackles in all lobes on auscultation

1 Applying a binder on fractured ribs can reduce the chest expansion and retain secretions. Therefore, the patient will have the risk of atelectasis. Chylothorax is complication of chest trauma, which results from disruption of the thoracic duct. Hemopneumothorax is the presence of blood in the pleural cavity due to chest trauma. Pulmonary embolism is a blockage of pulmonary a blood vessel due to thrombus formation; this complication is not associated with application of a binder. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. Text Reference - p. 543

Which complication does the nurse expect when a patient with fractured ribs is wearing a binder on the chest? 1 Atelectasis 2 Chylothorax 3 Hemopneumothorax 4 Pulmonary embolism

1 The image depicts a lung during inspiration and indicates paradoxic breathing as the chest is sucked in during inspiration. This indicates flail chest. Cardiac tamponade is a complication associated with the presence of excess fluids in the heart, which increases pressure on the heart. Iatrogenic pneumothorax is a type of chest trauma associated with a laceration on the lung that occurs during medical procedures. Traumatic pneumothorax is chest trauma associated with excess air in the chest cavity due to an opening in the chest wall. Text Reference - p. 544

Which complication is indicated in the image? 1 Flail chest 2 Cardiac tamponade 3 Iatrogenic pneumothorax 4 Traumatic pneumothorax

4 Spontaneous pnemothorax is a complication that results from rupture of blebs located in the lung. This complication is seen in patients with pulmonary diseases such as asthma and chronic obstructive pulmonary disease. Tension pneumothorax is a complication associated with the presence of excessive air in the pleural thorax that cannot escape. This condition results in increased intracranial pressure. Traumatic pnemothorax is a type of chest trauma associated with an opening in the pleural space that results in air entering the pleural space. Iatrogenic pneumothorax is a type of chest trauma, which occurs due to laceration or puncture of the lung. Text Reference - p. 542

Which condition does the nurse expect is present in a patient with chronic obstructive pulmonary disorder (COPD) who has a rupture of small blebs on the apex of the lung? 1 Tension pneumothorax 2 Traumatic pneumothorax 3 Iatrogenic pneumothorax 4 Spontaneous pnemothorax

1 Flail chest results in loss of chest stability due to fracture of the ribs. The patient with loss of chest stability requires positive pressure ventilation to ensure proper respiration. The nurse performs needle decompression to treat the cardiac tamponade effectively. The patient with hemopneumothorax or tension pneumothorax requires treatment with chest tube drainage and positive pressure ventilation aggravates the patient's condition. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. Text Reference - p. 542

Which condition in a patient with chest trauma requires treatment of positive pressure ventilation? 1 Flail chest 2 Cardiac tamponade 3 Hemopneumothorax 4 Tension pneumothorax

4 Secondary pulmonary arterial hypertension increases with chronic pulmonary arterial pressure and leads to right ventricular hypertrophy and failure. Increased pulmonic and S4 heart sounds and hepatomegaly are the pathologic signs of right-sided heart failure. Pulmonary effusion is indicated by decreased breath sounds. Acute pulmonary embolism is determined by accentuating pulmonic heart sound. Idiopathic pulmonary fibrosis is identified by crackles heard during inspiration. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 554

Which condition is suspected in a patient with increased pulmonic and S4 heart sounds, and hepatomegaly? 1 Pulmonary effusion 2 Acute pulmonary embolism 3 Idiopathic pulmonary fibrosis 4 Secondary pulmonary arterial hypertension

2 The normal flow of drainage is below 100 mL/hr. Fluid level drainage of 120 mL/hr indicates excessive drainage or/and increases the risk of further complications, and this requires the immediate attention of the primary health care provider. The presence of yellow or bloody fluid would indicate that the patient may have complications; however, the fluid is clear, indicating no risk of injury or infection. While adjusting the chest drainage tube, the nurse should ensure that the water level in the suction chamber is 20 cm and the water seal chamber is 2 cm. This will ensure that the suction is appropriate. Test-Taking Tip: Recall the normal values of fluid in the seal chamber and drainage. Which value do you think indicates deviation from normal value? This will help you choose the correct option. Text Reference - p. 546

Which finding in a patient who is on a chest drainage system requires attention of the primary health care provider immediately? 1 The fluid has clear appearance. 2 The fluid level drained is 120 mL/hr. 3 The water level in suction chamber is 20 cm. 4 The water level in water seal chamber is 2 cm.

4 Maintaining a semi-Fowler's position allows gravity to enhance respirations and increase airflow into the lungs. This especially is helpful in reducing the amount of dyspnea that the patient experiences. Postural drainage positions are used in the setting of excess lung secretions. Morphine and pursed lip breathing may be used to reduce anxiety, which this patient is not experiencing. Text Reference - p. 540

Which intervention should the nurse perform to reduce dyspnea in a patient with lung cancer? 1 Place the patient in postural drainage positions 2 Administer morphine 3 Teach the patient pursed-lip breathing 4 Elevate the head of the bed to 45 degrees

1, 2, 4 Several interventions may help the patient expectorate mucus, including increasing fluid intake, which will liquefy the secretions so that the patient can expectorate them more easily, humidifying the oxygen to loosen secretions, and elevating the head of the bed to increase movement of mucous. Pursed lip breathing and a cough suppressant will not promote mucus production and expectoration. Text Reference - p. 527

Which nursing interventions will the nurse implement to increase mucus production in a 72-year-old patient with bronchitis? Select all that apply. 1 Humidify the oxygen 2 Increase fluid intake to 3 L per day if tolerated 3 Administer a cough suppressant 4 Elevate the head of the bed to 45 degrees 5 Teach pursed lip breathing

2 A patient with heart failure has increased hydrostatic pressure, which may cause pleural fluid accumulation in the pleural cavity during pleural effusion. Collection of purulent fluid in the pleural space is empyema and could be caused by pneumonia. Malignancies are associated with increased capillary permeability that may lead to exudative pleural effusion. Chronic liver diseases, such as liver cirrhosis, may cause transudate pleural effusion that may occur as a result of decreased oncotic pressure. Text Reference - p. 549

Which patient is suspected of having transudate pleural effusion because of increased hydrostatic pressure? 1 A patient with pneumonia 2 A patient with heart failure 3 A patient with malignancies 4 A patient with liver cirrhosis

3 A patient with alpha1-antitrypsin deficiency has an inability to restore the lung elasticity; therefore, lung transplantation is indicated in this patient. Lung transplantation involves immunosuppressant treatment, which may not be tolerated in patients with poor nutritional status, chronic active hepatitis B, and human immunovirus infection. Text Reference - p. 556

Which patient would benefit from a lung transplant? 1 A patient with poor nutritional status 2 A patient with chronic active hepatitis B 3 A patient with alpha1-antitrypsin deficiency 4 A patient with human immunovirus infection

1 The presence of adventitious breath sounds indicates that there is accumulation of secretions in the lower airways. This would be consistent with a nursing diagnosis of ineffective airway clearance because the patient is retaining secretions. The rapid respiratory rate, low oxygen saturation, and presence of greenish sputum may occur with a lower respiratory problem, but do not support definitely the nursing diagnosis of ineffective airway clearance. Text Reference - p. 524

Which physical assessment finding in a patient with a lower respiratory problem best supports the nursing diagnosis of ineffective airway clearance? 1 Basilar crackles 2 Respiratory rate of 28 3 Oxygen saturation of 85% 4 Presence of greenish sputum

1 Small tubes having the size in the range of 12F to 24F are used to drain air from the patient's chest. Medium tubes in the range of 24F to 36F are used for draining fluid from the patient's chest. Large tubes ranging from 36F to 40F are used for draining blood from the patient's chest. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 544

Which sized chest tube does the nurse use to drain air from the patient's chest? 1. 14F 2. 26F 3. 36F 4. 40F

1 The water seal chamber is the second chamber of the chest drainage system. It contains 2 cm of water, which acts as a one-way valve. The first chamber of the drainage system receives fluid and air from the pleural space. The third chamber applies suction to the chest drainage system. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. Text Reference - p. 545

Which statement is true regarding a water seal chamber? 1 It contains 2 cm of water. 2 It acts as a two-way valve. 3 It receives fluid and air from the pleural space. 4 It applies suction to the chest drainage system

2, 3, 5 Coughing and deep breathing exercises will open the pores of Kohn in the lungs and relieve atelectasis. Incentive spirometer will assist in clearing the lungs and will reduce the risk of atelectasis. The nurse instructs the patient to perform range-of-motion exercises because doing so reduces the risk of atelectasis. The nurse instructs the patient to change position slowly if he or she has hypotension. Protein is essential and does not cause any complications for atelectasis. Test-Taking Tip: You should recollect the measures to be followed to prevent the risk of atelectasis in the patient with chest wall injury to answer this question accurately. Text Reference - p. 547

Which statement made by the patient indicates effective learning about the interventions to be followed to reduce the risk of atelectasis while undergoing chest tube drainage? Select all that apply. 1 "I should change position slowly." 2 "I should cough at regular intervals." 3 "I should perform incentive spirometer." 4 "I should reduce intake of protein in my diet." 5 "I should perform range-of-motion exercises."

3 An oxygen saturation level that drops below 90% with activity indicates that the patient is not tolerating the exercise and needs to use supplemental oxygen. The patient will need to rest to resaturate. ABGs or moving the probe will not be needed, because the pulse oximeter was working at the beginning of the walk. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. Text Reference - p. 540

While ambulating a patient with metastatic lung cancer, the nurse observes a drop in oxygen saturation from 93% to 86%. Which most appropriate nursing intervention is based upon these findings? 1 Continue with ambulation because this is a normal response to activity. 2 Obtain a health care provider's prescription for arterial blood gas (ABG) determinations to verify the oxygen saturation. 3 Obtain a health care provider's prescription for supplemental oxygen to be used during ambulation and other activity. 4 Move the oximetry probe from the finger to the earlobe for more accurate monitoring during activity.

2 The suction chamber is covered with a muffler because the continuous boiling is noisy and it may disturb the patient. The absence of bubbles in the chamber will reduce the pleural air leak but closing the chamber with a muffler will not. The muffler will reduce evaporation but will not increase the bubbling. The suction from the chamber is increased when slight bubbles form in the water. Text Reference - p. 546

While monitoring a patient who is on a wet chest drainage system, the nurse covers the suction control chamber with a muffler. What is the reason for this intervention? 1 To reduce the pleural air leak 2 To reduce the noise of the chamber 3 To increase the bubbling of the water 4 To increase the suction from the chamber

4 While planning to remove the chest drainage tube, the primary health care provider clamps the chest tube a few hours before removal to assess the patient's tolerance after removal. Adequate patient teaching is provided to minimize the risk of atelectasis and to reduce the risk of shoulder stiffness. Meticulous sterile technique during dressing changes is followed to reduce the incidence of infected sites. Text Reference - p. 547

Why does the primary health care provider, while managing a patient who is on chest drainage, clamp the chest tube a few hours before removal? 1 To minimize the risk of atelectasis 2 To reduce the risk of shoulder stiffness 3 To reduce the incidence of infected sites 4 To assess the patient's tolerance after removal