MedSurg mutlichapter PU test review

The nurse is educating the patient diagnosed with acute pharyngitis on methods to alleviate discomfort. What interventions should the nurse include in the information? (Select all that apply.) A. apply an ice collar. b. Stay on bed rest during the febrile stage of the illness. c. Gargle with an alcohol-based mouthwash. d. Try a liquid or soft diet during the acute stage of the disease. e. Drink warm or hot liquids during the acute stage of the disease.

A. apply an ice collar. b. Stay on bed rest during the febrile stage of the illness. c. Gargle with an alcohol-based mouthwash. A liquid or soft diet is provided during the acute stage of the disease, depending on the patient's appetite and the degree of discomfort that occurs with swallowing. Cool beverages, warm liquids, and flavored frozen desserts such as ice pops are often soothing. The nurse instructs the patient to stay in bed during the febrile stage of illness and to rest frequently once up and about. Depending on the severity of the pharyngitis and the degree of pain, warm saline gargles or throat irrigations are used. An ice collar also can relieve severe sore throats.

The nurse is caring for a client in the ICU who is receiving mechanical ventilation. Which nursing measure is implemented in an effort to reduce the client's risk of developing ventilator-associated pneumonia (VAP)? a. Cleaning the client's mouth with chlorhexidine daily b. Maintaining the client in a high Fowler's position d. Ensuring that the client remains sedated while intubated e. Turning and repositioning the client every 4 hours

a. Cleaning the client's mouth with chlorhexidine daily The five key elements of the VAP bundle include elevation of the head of the bed (30 to 45 degrees [semi-Fowler's position)], daily "sedation vacations," and assessment of readiness to extubate; peptic ulcer disease prophylaxis (with histamine-2 receptor antagonists, such as ranitidine [Zantac]); deep venous thrombosis prophylaxis; and daily oral care with chlorhexidine (0.12% oral rinses). The client should be turned and repositioned every 2 hours to prevent complications of immobility and atelectasis and to optimize lung expansion.

The nurse is educating the patient in the use of a mini-nebulizer. What should the nurse encourage the patient to do? (Select all that apply.) a. Hold the breath at the end of inspiration for a few seconds. b. Cough frequently. c. Take rapid, deep breaths. d. Frequently evaluate progress. e. Prolong the expiratory phase after using the nebulizer.

a. Hold the breath at the end of inspiration for a few seconds. b. Cough frequently. d. Frequently evaluate progress.

Asthma is cause by which type of response? a. IgE-mediated b. IgA-mediated c. IgD-mediated d. IgM-mediated

a. IgE-mediated

Which of the following is the key underlying feature of asthma? a. Inflammation b. Shortness of breath c. Productive cough d. Chest tightness

a. Inflammation Inflammation is the key underlying feature and leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheeze, and dyspnea.

A patient diagnosed with diabetic ketoacidosis would be expected to have which type of respiratory pattern? a. Kussmaul respirations b. Cheyne-Stokes c. Biot's respirations d. Apnea

a. Kussmaul respirations

A young male client has muscular dystrophy. His PaO2 is 42 mm Hg with a FiO2 of 80%. Which of the following treatments would be least invasive and most appropriate for this client? a. Negative-pressure ventilator b. Positive-pressure ventilator c. Continuous positive airway pressure (CPAP) d. Bilevel positive airway pressure (Bi-PAP)

a. Negative-pressure ventilator This client needs ventilatory support. His PaO2 is low despite receiving a high dose of oxygen. The iron lung or drinker respiratory tank is an example of a negative-pressure ventilator. This type of ventilator is used mainly with chronic respiratory failure associated with neurological disorders, such as muscular dystrophy. It does not require intubation of the client. The most common ventilator is the positive-pressure ventilator, but this involves intubation with an endotracheal tube or tracheostomy. CPAP is used for obstructive sleep apnea. Bi-PAP is used for those with severe COPD or sleep apnea who require ventilatory assistance at night.

Which is a key characteristic of pleurisy? a. Pain b. Dyspnea c. Anxiety d. Blood-tinged secretions

a. Pain

A patient has had a laryngectomy and was able to retain his airway, with no difficulty swallowing. There is no split of thyroid cartilage. The nurse would record this type of laryngectomy as which of the following? a. Partial laryngectomy b. Supraglottic laryngectomy c. Hemilaryngectomy d. Total laryngectomy

a. Partial laryngectomy

Which of the following interventions would be helpful for a client reporting nasal congestion, sneezing, sore throat, and muscle aches? Select all that apply. a. Provide warm salt-water gargles. b. Administer oral ibuprofen. c. Teach the client about handwashing. d. Refer the client to a physician for antibiotic therapy. e. Recommend guaifenesin.

a. Provide warm salt-water gargles. b. Administer oral ibuprofen. c. Teach the client about handwashing. e. Recommend guaifenesin.

A client continues to report dyspnea on exertion and overall weakness. A pulmonary artery catheter is placed and the mean pulmonary arterial pressure is 35 mm Hg. What condition is the client experiencing? a. Pulmonary arterial hypertension b. Restrictive lung disease c. Asthma d. Atelectasis

a. Pulmonary arterial hypertension Pulmonary hypertension (PH) is confirmed with a mean pulmonary artery pressure greater than 25 mm Hg. The main symptom of PH is dyspnea. Client with restrictive lung disease, asthma, and atelectasis should not have PH.

A client with COPD has been receiving oxygen therapy for an extended period. What symptoms would be indicators that the client is experiencing oxygen toxicity? Select all that apply. a. Substernal pain b. Dyspnea c. Fatigue d. Mood swings e. Bradycardia

a. Substernal pain b. Dyspnea c. Fatigue Oxygen toxicity can occur when clients receive too high a concentration of oxygen for an extended period. Symptoms include dyspnea, substernal pain, restlessness, fatigue, and progressive respiratory difficulty. Bradycardia and mood swings are not symptoms of oxygen toxicity.

Which technique does the nurse suggest to a client with pleurisy while teaching about splinting the chest wall? a. Turn onto the affected side. b. Use a prescribed analgesic. c. Avoid using a pillow while splinting. d. Use a heat or cold application.

a. Turn onto the affected side. The nurse teaches the client to splint the chest wall by turning onto the affected side. The nurse also instructs the client to take analgesic medications as prescribed and to use heat or cold applications to manage pain with inspiration. The client can also splint the chest wall with a pillow when coughing.

A client has been newly diagnosed with emphysema. The nurse should explain to the client that by definition, ventilation: a. is breathing air in and out of the lungs. b. is when the body changes oxygen into CO2. c. provides a blood supply to the lungs. d. helps people who cannot breathe on their own.

a. is breathing air in and out of the lungs.

The herpes simplex virus type 1 (HSV-1), which produces a cold sore (fever blister), has an incubation period of a. 2 to 12 days b. 20 to 30 days c. 1 to 3 months d. 3 to 6 months

a. 2 to 12 days

The nurse knows that a sputum culture is necessary to identify the causative organism for acute tracheobronchitis. What causative fungal organism would the nurse suspect? a. Aspergillus b. Haemophilus c. Mycoplasma pneumoniae d. Streptococcus pneumoniae

a. Aspergillus the only one that is a fungus out of the answers

Which of the following occupy space in the thorax, but do not contribute to ventilation? a. Bullae b. Alveoli c. Lung parenchyma d. Mast cells

a. Bullae Bullae are enlarged airspaces that do not contribute to ventilation but occupy space in the thorax. Bullae may compress areas of healthier lung and impair gas exchange.

A client with a pulmonary embolus has the following arterial blood gas (ABG) values: pH, 7.49; partial pressure of arterial oxygen (PaO2), 60 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 30 mm Hg; bicarbonate (HCO3-) 25 mEq/L. What should the nurse do first? a. Instruct the client to breathe into a paper bag. b. Administer oxygen by nasal cannula as ordered. c. Auscultate breath sounds bilaterally every 4 hours. d. Encourage the client to deep-breathe and cough every 2 hours.

b. Administer oxygen by nasal cannula as ordered. When a pulmonary embolus places a client at risk for oxygen deprivation, the body compensates by hyperventilating. This causes respiratory alkalosis, as reflected in the client's ABG values. However, the most significant ABG value is the PaO2 value of 60 mm Hg, which indicates hypoxemia. To manage hypoxemia, the nurse should increase oxygenation by administering oxygen via nasal cannula as ordered. Instructing the client to breathe into a paper bag would cause depressed oxygenation when the client reinhaled carbon dioxide. Auscultating breath sounds or encouraging deep breathing and coughing wouldn't improve oxygenation.

A client with severe shortness of breath comes to the emergency department. He tells the emergency department staff that he recently traveled to China for business. Based on his travel history and presentation, the staff suspects severe acute respiratory syndrome (SARS). Which isolation precautions should the staff institute? a. Droplet precautions b. Airborne and contact precautions c. Contact and droplet precautions d. Contact precautions

b. Airborne and contact precautions

An adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Ordered respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure? a. Immediately before a meal b. At bedtime c. When bronchospasms occur d. When secretions have mobilized

b. At bedtime The nurse should perform chest physiotherapy at bedtime to reduce secretions in the client's lungs during the night.

The nurse is obtaining data from a client with a respiratory disorder. Which information would be considered a part of the functional assessment and would assist in the diagnosis of an occupational lung disease? a. Cough and dyspnea b. Black-streaked sputum c. Tenacious secretions d. Barrel chest

b. Black-streaked sputum A functional assessment provides data on the lifestyle, living environment, and work environment of the client, which can contribute to lung disorders. A black-tinged sputum is suggestive of prolonged exposure to coal dust.

A son brings his father into the clinic, stating that his father's color has changed to bluish around the mouth. The father is confused, with a respiratory rate of 28 breaths per minute and scattered crackles throughout. The son states this condition just occurred within the last hour. Which of the following factors indicates that the client's condition has lasted for more than 1 hour? a. Respiratory rate b. Cyanosis c. Son's statement d. Crackles

b. Cyanosis The client's appearance may give clues to respiratory status. Cyanosis, a bluish coloring of the skin, is a very late indicator of hypoxia. The presence of cyanosis is from decreased unoxygenated hemoglobin.

The nurse is caring for a client in the immediate post-thoracentesis period. In which position is the client placed? a. In the supine position b. Lying on the unaffected side c. In the high Fowler's position d. Prone with a pillow under the head

b. Lying on the unaffected side

Class 1 with regard to TB indicates a. no exposure and no infection. b. exposure and no evidence of infection. c. latent infection with no disease. d. disease that is not clinically active.

b. exposure and no evidence of infection.

Which ventilator mode provides full ventilatory support by delivering a preset tidal volume and respiratory rate? a. IMV b. SIMV c. Assist control d. Pressure support

c. Assist control Assist-control ventilation provides full ventilator support by delivering a preset tidal volume and respiratory rate. Intermittent mandatory ventilation (IMV) provides a combination of mechanically assisted breaths and spontaneous breaths. SIMV delivers a preset tidal volume and number of breaths per minute. Between ventilator-delivered breaths, the client can breathe spontaneously with no assistance from the ventilator for those extra breaths. Pressure support ventilation assists SIMV by applying a pressure plateau to the airway throughout the client-triggered inspiration to decrease resistance within the tracheal tube and ventilator tubing.

A nurse caring for a patient with a pulmonary embolism understands that a high ventilation-perfusion ratio may exist. What does this mean for the patient? a. Perfusion exceeds ventilation. b. There is an absence of perfusion and ventilation. c. Ventilation exceeds perfusion. d. Ventilation matches perfusion.

c. Ventilation exceeds perfusion. A high ventilation-perfusion rate means that ventilation exceeds perfusion, causing dead space. The alveoli do not have an adequate blood supply for gas exchange to occur. This is characteristic of a variety of disorders, including pulmonary emboli, pulmonary infarction, and cardiogenic shock.

A client who has started therapy for drug-resistant tuberculosis demonstrates understanding of tuberculosis transmission when he says: a. "My tuberculosis isn't contagious after I take the medication for 24 hours." b. "I'm clear when my chest X-ray is negative." c. "I'm contagious as long as I have night sweats." d. "I'll stop being contagious when I have a negative acid-fast bacilli test."

d. "I'll stop being contagious when I have a negative acid-fast bacilli test." A client with drug-resistant tuberculosis isn't contagious when he's had a negative acid-fast test. A client with nonresistant tuberculosis is no longer considered contagious when he shows clinical evidence of decreased infection, such as significantly decreased coughing and fewer organisms on sputum smears. The medication may not produce negative acid-fast test results for several days. The client won't have a clear chest X-ray for several months after starting treatment. Night sweats are a sign of tuberculosis, but they don't indicate whether the client is contagious.

The nurse assessed a 28-year-old woman who was experiencing dyspnea severe enough to make her seek medical attention. The history revealed no prior cardiac problems and the presence of symptoms for 6 months' duration. On assessment, the nurse noted the presence of both inspiratory and expiratory wheezing. Based on this data, which of the following diagnoses is likely? a. Acute respiratory obstruction b. Adult respiratory distress syndrome c. Pneumothorax d. Asthma

d. Asthma The presence of both inspiratory and expiratory wheezing usually signifies asthma if the individual does not have heart failure. Sudden dyspnea is an indicator of the other choices.

A physician determines that a client has been exposed to someone with tuberculosis. The nurse expects the physician to order which treatment? a. Daily oral doses of isoniazid (Nydrazid) and rifampin (Rifadin) for 6 months to 2 years b. Isolation until 24 hours after antitubercular therapy begins c. Nothing, until signs of active disease arise d. Daily doses of isoniazid, 300 mg for 6 months to 1 year

d. Daily doses of isoniazid, 300 mg for 6 months to 1 year All clients exposed to persons with tuberculosis should receive prophylactic isoniazid in daily doses of 300 mg for 6 months to 1 year to avoid the deleterious effects of the latent mycobacterium. Daily oral doses of isoniazid and rifampin for 6 months to 2 years are appropriate for the client with active tuberculosis. Isolation for 2 to 4 weeks is warranted for a client with active tuberculosis.

The nurse is assessing a patient who has been admitted with possible ARDS. What findings would distinguish ARDS from cardiogenic pulmonary edema? a. Elevated white blood count b. Elevated troponin levels c. Elevated myoglobin levels d. Elevated B-type natriuretic peptide (BNP) levels

d. Elevated B-type natriuretic peptide (BNP) levels Common diagnostic tests performed in patients with potential ARDS include plasma brain natriuretic peptide (BNP) levels, echocardiography, and pulmonary artery catheterization. The BNP level is helpful in distinguishing ARDS from cardiogenic pulmonary edema.

A patient with emphysema is placed on continuous oxygen at 2 L/min at home. Why is it important for the nurse to educate the patient and family that they must have No Smoking signs placed on the doors? a. Oxygen is combustible. b. Oxygen is explosive. c. Oxygen prevents the dispersion of smoke particles. d. Oxygen supports combustion.

d. Oxygen supports combustion. Because oxygen supports combustion, there is always a danger of fire when it is used. It is important to post "No Smoking" signs when oxygen is in use, particularly in facilities that are not smoke free.

The nurse assesses a patient for a possible pulmonary embolism. What frequent sign of pulmonary embolus does the nurse anticipate finding on assessment? a. Cough b. Hemoptysis c. Syncope d. Tachypnea

d. Tachypnea The most frequent sign is tachypnea (very rapid respiratory rate).