respiratory questions

A nurse is reading the results of a Mantoux skin test on a client with no documented health problems. The site has no induration and a 1-mm area of ecchymosis. The nurse interprets that the result is: 1. positive 2. Negative 3. Uncertain 4. Borderline

2. positive skin test has an induration of 10mm or more in diameter in low-risk individuals a small area of ecchymosis is insignificant and is probably related to injection technique

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

1, 3, 4, 5, The nurse is to educate the client and family about TB. The nurse should inform and ask the client to follow the medication regime exactly as how it is prescribed and always have supply of medication on hand. The client is informed about the side effects of the medication and how minimize or prevent them. The client should know that after the first 2-3 weeks of therapy, the client is unlikely to be contagious Physical activities are to be resumed gradually The client is asked to have an adequate nutrition in his or her diet: enough vitamin C, protein, and iron to promote healing and prevents recurrence The client does not need respiratory isolation since the family members are already exposed. The client and family members are asked to practice hand washing hygiene carefully, cover mouth and nose when cough or sneeze, and confine the used tissues to plastic bags. Client is to have sputum culture obtained every 2-4 week after the medication is initiated. The client could go back to work after three sputum cultures are negative and no longer considered infectious.

A nurse is assisting in planning car for a client scheduled for insertion of a tracheostomy. What equipment would the nurse plan to have at the bedside when the client returns from surgery? 1. Obturator 2. Oral airway 3. Epinephrine 4. Tracheostomy tube with the next larger size

1. A same size tracheostomy and an obturator is kept at the bedside at all times in case the tracheostomy tube is dislodged. Also, a curved hemostat that could be used to hold the trachea open if dislodgment occurs should also be kept at the bedside.

A client with acquired immunodeficiency syndrome (AIDS) has histoplasmosis. A nurse checks the client for which signs/symptom? 1. Dyspnea 2. Headache 3. Weight gain 4. Hypothermia

1. Histoplasmosis is an opportunistic fungal infection that can occur in the client with AIDS. The infection begins as a respiratory infection and can progress to disseminated infection. Typical signs and symptoms include: fever, dyspnea, cough, and weight loss. There may be enlargement of the client's lymph nodes, liver, and spleen as well.

A client with tuberculosis (TB) asks a nurse about precautions to take after discharge from the hospital to prevent infection of others. The nurse develops a response to the client's question based on the understanding that: 1. The disease is transmitted by droplet nuclei 2. The client should maintain enteric precautions only 3. Deep pile carpet should be removed from the home 4. Clothing and sheets should be bleached after each use

1. TB spreads by droplet nuclei or airborne route. Family members should practice good hand washing hygiene The disease is not carried on objects such as clothing, eating utensils, linens, or furniture. Bleaching and washing them or remove the carpet from home would be unnecessary.

A nurse is assigned to care for a client following a left pneumonectomy. The nurse would avoid positioning the client: 1. On the side 2. In a low Fowler's position 3. In a semi-Fowler's position 4. With the head of the bed elevated 40 degrees

1. complete lateral position should be avoided following pneumonectomy. Because the mediastinum is no longer held in place on both sides by lung tissue, lateral positioning may cause mediastinal shift and compression of the remaining lung.

A nurse is caring for a client with a n endotracheal tube attached to a ventilator. The high-pressure alarm sounds on the ventilator. The nurse prepares to perform which nursing intervention? 1. Suction the client 2. Check for a disconnection 3. Notify the respiratory therapist 4. Evaluate the tube cuff for a leak

1. high-pressure alarm is caused by an obstruction of client bitting on the tube, kinking got the tubbing, or mucus plugging requiring suctioning. It is also important to check the tubing for presence of any water and determine if the client is out of rhythm with breathing with the ventilator. A disconnection or a cuff leak can result in sounding of the low-pressure alarm. A respiratory therapist would be notified if the nurse could not determine the cause of the alarm.

A nurse is taking the nursing history of a client with silicosis. The nurse checks whether the client wears which of the following items during period of exposure to silica particles? 1. Mask 2. Gown 3. Gloves 4. Eye protection

1. silicosis is a lung disease caused by chronic and excessive inhalation of crystalline silica dust. The client should wear a mask to prevent inhalation of crystalline silica dust.

A nurse is preparing to obtain a sputum specimen from the client. Which nursing action will facilitate obtaining the specimen? 1. Limiting fluids 2. Having the client take three deep breaths 3. Asking the client to obtain the specimen after eating 4. Asking the client to spit into the collection container

2. The optimal time to obtain the sputum culture is on raise in the morning. To enhance the result of the sputum culture, the client should brush his or her teeth to reduce mouth contamination. The client should take three deep breaths and cough into a sputum specimen container. The client should be encouraged to cough and not spit so that sputum can be obtained

An emergency room nurse is caring for a client who sustained a blunt injury to the chest wall. Which sign, if noted in the client, would indicate the presence of a pneumothorax? 1. Bradypnea 2. Shortness of breath 3. A low respiratory rate 4. The presence of a barrel chest

2. a blunt injury to chest wall is a closed chest injury. The signs and symptoms of a closed pneumothorax are: SOB and chest pain. A larger pneumothorax have the signs of tachycardia, diminished breath sound, cyanosis, and subcutaneous emphysema. There may also be hyper resonance on the affected side.

A client with tuberculosis,, whose status is being monitored in an ambulatory care clinic, asks the nurse when it is permissible to return to work. The ruse replies that the client may resume employment when: 1. Five sputum cultures are negative 2. Three sputum cultures are negative 3. A sputum culture and a chest x-ray are negative 4. A sputum culture and a Mantoux test are negative

2.

A nurse is caring for a client hospitalized with acute exacerbate of chronic obstructive pulmonary disease (COPD). Which o the following would the nurse expect to note in evaluating this client? 1. Hypocapnia 2. A hyperinflated chest on x-ray 3. Increased oxygen saturation with exercise 4. A widened diaphragm noted on chest x-ray

2. Clinical manifestations of COPD include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise and the use of accessory muscles of respiration . Chest x-ray will reveal a hyper inflated chest and a flattened diaphragm if the disease is advanced.

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

2. The nurse who is in contact with a client with TB should wear an individually fitted particulate respirator. The nurse would also wear gloves as per standard precautions. The nurse wears a gown whenever there is a possibility that the clothing could become contaminated, such as when giving a bed bath.

A nurse is caring for a client with emphysema who is receiving oxygen. The nurse checks the oxygen flow rate to ensure that it does not exceed: 1. 1 L/minute 2. 2 L/minute 3. 6 L/minute 4. 10 L/minute

2. emphysema patients' drive of breathing is triggered by low oxygen level; so make sure the oxygen level does not exceed 2 L/minute. Normally, breathing drive is triggered by high carbon dioxide level; level of oxygen by NC is 1 L/minute - 3 L/minute. This would raise the oxygen to 60-80 mmHg.

A nurse is caring for a client following pulmonary angiography via catheter insertion into the left groin. The nurse monitors for an allergic reaction to the contrast medium by noting the presence of: 1. Hypothermia 2. Respiratory distress 3. Hematoma in the left groin 4. Discomfort in the left groin

2. signs of allergic reaction to the contrast medium include: localized itching and edema, respiratory distress, stridor, and decreased blood pressure.

A nurse is gathering data on a client with a diagnosis of tuberculosis (TB). The nurse reviews the results of which diagnostic test that will confirm this diagnosis? 1. Chest x-ray 2. Bronchoscopy 3. Sputum culture 4. Tuberculin skin test

3. A definitive diagnosis of TB is confirmed through culture and isolation of Mycobacterium tuberculosis. A presumptive diagnosis is made on the basis of a tuberculin skin test, a sputum smear that is positive for acid-fast bacteria, a chest x-ray, and histologic evidence of granulomatous disease on biopsy.

The low-pressure alarm sounds on the ventilator. The nurse checks the client and then attempts to determine the cause of the alarm but is unsuccessful. Which initial action will the nurse take? 1. Administer oxygen 2. Check the client's vital signs 3. Ventilate the client manually 4. Start cardiopulmonary resuscitation (CPR)

3. If no cause could be detected right away, disconnect the ventilator and use a manual ventilator to temporarily ventilate the patient until the ventilator is fixed.

Which of the following identifies that route of transmission of tuberculosis (TB)? 1. Hand to mouth 2. The enteric route 3. The airborne route 4. Blood and body fluids

3. airborne route is the primary route of TB spreading.

A nurse working on a respiratory nursing unit is caring for several client sixth respiratory disorders. The nurse would identify which of the following clients as being at the least risk for developing infection with tuberculosis? 1. An uninsured man who is homeless 2. A woman newly immigrated from Korea 3. A man who is an inspector for the U.S. Postal Service 4. An older woman admitted from a long-term care facility

3. people at high risk for acquiring tuberculosis include immigrants from Asia, Africa, Latin America, and Central and South Pacific regions; medically underserved populations (ethnic minorities, homeless); those with human immunodeficiency virus or other immunosuppressive disorders; residents in gouts settings (long-term care, correctional facilities); and health care workers.

A nurse is providing discharge instructions to the client with pulmonary sarcoidosis. The nurse determines that the client understands the information if the client verbalizes which early signs of exacerbation? 1. Fever 2. Fatigue 3. Weight loss 4. Shortness of breath

4. SOB is an early sign of exacerbation of pulmonary sarcoidosis. Other include chest pain, hemoptysis, and pneumothorax. Systemic signs and symptoms that occur later include weakness and fatigue, malaise, fever, and weight loss.

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

4. The client is general not contagious after 2 to 3 weeks of medication therapy. The client will take medication for 6-12 weeks depending on the client's progress. During therapy, the client is asked to wear a mask when in a crowd or places where are many people until medication is effective in preventing transmission. The client can go back to work after three sputum cultures are negative.

A nurse is providing instructions to a hospitalized client with a diagnosis of emphysema about positions that will enhance the effectiveness of breathing during dyspneic periods. Which position will the nurse instruct the client to assume? 1. Sitting up in bed 2. side-lying in bed 3. sitting in a recliner chair 4. sitting on the side of the bed leaning on an overbid table

4. positions that will assist the client with breathing include sitting up and leaning on an overbid table, sitting up and resting with the elbows on the knees, or standing or leaning against the wall.

A nurse is instructing a client about pursed lip breathing and the client asks the nurse about its purpose. The nurse tells the client that the primary purpose of pursed lip breathing is to: 1. Promote oxygen intake 2. Strengthen the diaphragm 3. Strengthen the intercostal muscles 4. Promote carbon dioxide elimination

4. pursed lip breathing allows better expiration by increasing the airway pressure, which keeps the airway open during expiration.

A client being discharged from the hospital to home with a diagnosis of tuberculosis (TB) is worried about the possibility of infecting the daily and others. The nurse determines that the client would get the most reassurance from the knowledge that: 1. The family does not need therapy, and the client will not be contagious after 1 month of medication therapy 2. The family does not need therapy, and the client will not be contagious after 6 consecutive weeks of medicate therapy 3. The family will receive prophylactic therapy, and the client will not be contagious after 1 continuous week of medication therapy 4. The family will be treated prophylactically, and the client will not be contagious after 2 to 3 consecutive weeks of medication therapy

4. family members or others who have been in close contact with a client diagnosed with TB are placed on prophylactic therapy with isoniazid (INH) for 6 to 12 months. The client is usually not contagious after taking medication for 2 to 3 consecutive weeks. However, the client must take the flu course of therapy (for 6 months or longer) to prevent reinfection or drug resistant TB.