med/surg chapter 32

The nurse is teaching a client with bronchiolitis obliterans organizing pneumonia (BOOP) about corticosteroid therapy. What statement is accurate for the nurse to teach the client?

"A short course of therapy will help with acute episodes."

What information about nutrition does the nurse teach a client with chronic obstructive pulmonary disease (COPD)? (Select all that apply.)

"Avoid drinking fluids just before and during meals." "Rest before meals if you have dyspnea." "Have about six small meals a day."

The nurse is assessing a client with chronic obstructive pulmonary disease (COPD) to determine activity tolerance. Which questions elicit the most important information? (Select all that apply.)

"Do you have any difficulty sleeping?" "How long does it take to perform your morning routine?" "Have you lost any weight lately?"

Which statement indicates that the client understands teaching about the use of long-acting beta2 agonist medications?

"I will take this medication daily to prevent an acute attack."

What statement indicates that a client needs further teaching regarding therapy with salmeterol (Serevent)?

"I will use the drug when I have an asthma attack."

A client diagnosed with asthma has not responded well to medication. The client is concerned and asks the nurse, "What is wrong with me, and why am I not getting better?" What is the nurse's best response?

"It is possible that genetic testing may help."

A client with lung cancer refuses pain medications because he or she is "afraid of addiction." What is the nurse's best response?

"It is unlikely you will become addicted from taking medicine for pain."

The nurse is teaching a client with asthma about self-management. Which statement by the nurse is best?

"Keep a daily symptom and intervention diary."

A client has recently been placed on prednisone (Deltasone). What is the highest priority instruction the nurse will provide?

"Report any abdominal pain or dark-colored vomit."

A client has a chest tube. What assessment findings require immediate intervention from the nurse? (Select all that apply.)

"Silent chest" in the client with a pneumothorax Tracheal deviation in a client after chest traumaConstant bubbling in the water seal chamber in a client post chest surgery

Which statement indicates that a client understands teaching about the correct use of a corticosteroid medication?

"This drug is effective in decreasing the frequency of my asthma attacks."

The nurse is teaching a client with asthma how to avoid attacks. What information does the nurse give the client? (Select all that apply.)

"You should not dust your furniture." "Do not take aspirin."

What is the best instruction for a client who has step II (mild persistent) asthma?

"You will need daily inhaled low-dose steroids."

A client recently diagnosed with lung cancer is being taught by the nurse. What information does the nurse teach the client?

"You will receive 6 weeks of daily radiation therapy."

Which statement indicates that a client needs additional teaching about using an inhaler?

"I will soak my inhaler in water to clean it."

The nurse assesses a client with asthma and finds wheezing throughout the lung fields and decreased pulse oxygen saturation. In addition, the nurse notes suprasternal retraction on inhalation. What is the nurse's best action?

Administer oxygen and a rescue inhaler.

The nurse is caring for four clients with asthma. Which client does the nurse assess first?

Client whose heart rate is 120 beats/min

Which nursing intervention is an example of primary prevention for lung cancer?

Teaching people about smoking and secondhand smoke

The nurse is assessing a client with lung disease. Which symptom does the nurse intervene for first?

The client has bilateral dependent leg edema

The nurse is teaching a client to cough productively. Put the actions in proper sequence.

1. Assist the client to a sitting position with feet on the floor. 2. Have the client flex the head and hold a pillow to the stomach 3. Encourage the client to take several deep breaths. 4. Instruct the client to bend forward and to cough two or three times. 5. Have the client return to an upright position and take a deep breath.

Place the steps for obtaining a peak expiratory flow rate in the order in which they should occur.

1. Make sure the device reads zero or is at base level. 2. Stand up (unless you have a physical disability). 3. Take as deep a breath as possible. 4. Place the meter in your mouth, and close your lips around the mouthpiece. 5. Blow out as hard and as fast as possible for 1 to 2 seconds. 6. Write down the value obtained. 7. Repeat the process two additional times, and record the highest number in your chart.

The nurse assesses the following lung sounds in a client. What is the nurse's best action? (Click the media button to hear the audio clip.)

Administer a rescue inhaler.

A client with asthma has been having frequent asthma attacks. What is the nurse's best action?

Administer montelukast (Singulair).

The nurse assesses a client's chest tube and finds continuous bubbling in the water seal chamber. When the nurse clamps the chest tube close to the client's dressing, the bubbling stops. How does the nurse interpret this finding?

An air leak is present at the chest tube insertion site or in the thoracic cavity.

A client was diagnosed with lung cancer and appears distressed. The client states, "I am so afraid." What is the best action for the nurse to take?

Ask the client what is causing the most fear right now.

The home care nurse observes white patches on the oral mucosa of a client with severe, chronic airflow limitation. What is the nurse's best action?

Ask the client whether he or she uses a steroid inhaler.

The nurse is assessing a client with asthma. Scattered wheezes are noted, and the client's oxygen saturation is 88%. What other assessments are essential for the nurse to perform? (Select all that apply.)

Assess for accessory muscle use. Assess inspiration/expiration ratios. Assess the suprasternal notch. Assess mucous membranes.

The nurse assesses an older adult after an upper respiratory infection and notes the following lung sound on auscultation. What is the nurse's best action? (Click the media button to hear the audio clip.)

Assess the client for the development of asthma.

A client with asthma reports "not being able to take deep breaths." The nurse auscultates decreased breath sounds in the bases, and no wheezes. What is the nurse's best action?

Assess the client's oxygen saturation.

The nurse is caring for an older adult who reports experiencing frequent asthma attacks and severe arthritic pain. What action by the nurse is most appropriate?

Assess use of medication for arthritis.

The nurse is evaluating a client's response to medication therapy for asthma. The client has a peak flowmeter reading in the yellow zone. What does the nurse do next?

Assist the client to use a rescue inhaler.

A client with pulmonary fibrosis is being discharged home. What is the highest priority teaching need?

Avoiding infection

The nurse assesses a client receiving chemotherapy for lung cancer and notes red swollen mucous membranes and open sores in the mouth. The client reports mouth pain and difficulty swallowing. Which action does the nurse perform first?

Call the health care provider and hold chemotherapy.

A client's chest tube is accidentally dislodged. What action by the nurse is best?

Cover the insertion site with a sterile gauze and tape three sides.

Which symptoms in chronic lung disease require nursing intervention? (Select all that apply.)

Decreased peak flow Expiratory wheezing Stridor Change in sputum color and amount

The nurse is caring for a client with bronchiolitis obliterans organizing pneumonia (BOOP) and assesses decreased vital capacity during pulmonary function testing. What is the nurse's best action?

Document the finding in the client's chart

A client with lung cancer is lying flat in bed and reports shortness of breath. What action does the nurse take first?

Elevate the head of the bed.

A client is demonstrating diaphragmatic breathing for the nurse. Which action by the client shows adequate understanding of this breathing technique?

Having his or her hands on the abdomen

A client infected with Burkholderia cepacia is admitted to the unit. What is the nurse's priority action when caring for this client?

Keep the client isolated from other clients with cystic fibrosis.

The nurse is teaching a client with cystic fibrosis. What activity does the nurse teach as the priority?

Maintaining good nutrition

The nurse is teaching a client about different medications for asthma. Which medication does the nurse teach the client to administer to control the prolonged inflammatory response?

Montelukast (Singulair)

A client is undergoing radiation therapy as treatment for lung cancer and has developed esophagitis. Which is the best diet selection for this client?

Omelet, whole wheat bread

Which is the highest priority problem for a client with late-stage lung cancer?

Pain

The nurse is assessing a client who has a chest tube. Which assessment finding requires intervention by the nurse?

Pain at the insertion site

A client is using omalizumab (Xolair) for the first time. What is the priority nursing action?

Remain with the client and assess for anaphylaxis.

The nurse observes hematuria in a client receiving IV cyclophosphamide (Cytoxan). After notifying the health care provider, what intervention is the nurse's priority?

Stop the medication.

A client is undergoing lung reduction surgery. What is the nurse's highest priority preoperatively?

Teach about preoperative testing.

The nurse assesses a client who is on fluticasone (Flovent) and notes oral lesions. What is the nurse's best action?

Teach the client to rinse the mouth after Flovent use.

A client has a mediastinal chest tube. Which symptoms require the nurse's immediate intervention? (Select all that apply.)

Tracheal deviation Sudden onset of shortness of breath Drainage greater than 70 mL/hr Disconnection at Y site

A client with chronic obstructive pulmonary disease (COPD) reports social isolation. What does the nurse encourage the client to do?

Verbalize his or her thoughts and feelings.