Unit 3 Practice

4. A nurse is teaching a client who has emphysema about self-management strategies. Which of the following statements by the client indicates an understanding of the teaching?

"I will follow a daily diet high in calories and proteins" Clients who have emphysema have greater-than-usual nutritional requirements for calories and proteins and often need nutritional supplements between meals.

19. A nurse is evaluating teaching on a client who has a new prescription for montelukast to treat asthma. Which of the following statements by the client indicates an understanding of the teaching?

"I'll take this medication once a day in the evening" Client should take this medication on a daily basis in the evening.

17. A nurse is reviewing the client's medical record. Which of the following prescriptions should the nurse anticipate for a client who has a pneumothorax? For each potential provider's prescription, click to specify if the potential prescription is anticipated, non essential, or contraindicated for the client.

ANTICIPATED - ABG, prepare for insertion of a chest tube, obtain VI access. NON ESSENTIAL - CT of the chest, pulmonary function test CONTRAINDICATED - Thoracentesis Chest tube is needed for a patient with a pneumothorax to re-expand the lungs. Pneumothorax takes priority because of impaired gas exchange, CT can be performed after chest tube. Thoracentesis aspirates air or fluid but does not restore expansion of the lungs

15. A nurse in a clinic sees a client who has an acute asthma exacerbation. Which of the following medications should reduce the symptoms?

Albuterol via jet nebulizer Albuterol is the first line medication bronchodilator to stop bronchospasm or constriction in clients with asthma exacerbation

31. A nurse in the post-anesthesia care unit is caring for a client who is postoperative following a thoracotomy and lobectomy. Which of the following postoperative assessments should the nurse give highest priority to?

Arterial blood gases If chest tube drainage exceeds 70 ml/hr, the nurse, the nurse should monitor for bleeding.

27. A home health nurse visits a client who has COPD and receives oxygen at 2L/min via nasal cannula. The client reports difficulty breathing. Which of the following actions is the nurse priority?

Assess the client's respiratory status The nurse should immediately assess the client's respiration status before determining the appropriate interventions

11. A nurse is providing teaching to a client who has emphysema and a new prescription for theophylline. Which of the following instructions should the nurse provide?

Avoid caffeine while taking this medication The nurse should instruct the client that caffeine should be avoided while taking theophylline, as it can increase central nervous system stimulation. This medication should NOT be taken with food, high protein diet should be avoided, because it decreases theophylline method of action, increase fluids 2 liters per day.

30. A nurse is assessing a client who has COPD. The nurse should expect the client's chest to be which of the following shapes?

Barrel chest Clients with COPD use accessory muscles to assist with respiration effort increasing the anterior-posterior diameter, making it appear barrel shaped.

9. A nurse is observing the closed chest drainage system of a client who is 24 hours post thoracotomy. The nurse notes slow, steady bubbling in the suction control chamber. Which of the following actions should the nurse take?

Continue to monitor the client's respiratory status Slow, steady bubbling in the suction control chamber is an expected finding. Therefore, the nurse should continue to monitor the client's respiratory status.

14. A nurse is caring for a client who has emphysema. Which of the following findings should the nurse expect to assess in this client? Select all that apply:

Dyspnea Barrel chest Clubbing on the fingers Emphysema is damage to the alveoli causing it to weaken, loose elasticity, collapse, and hyperinflate. Signs and symptoms include dyspnea, tachycardia, barrel chest, clubbed fingers, and shallow respirations

28. A nurse is caring for a client who has chronic obstructive pulmonary disease (COPD). The client tells the nurse, "I can feel the congestion in my lungs, and I certainly cough a lot, but I can't seem to bring anything up". Which of the following actions should the nurse take to help this client with tenacious bronchial secretions?

Encourage the client to drink 2 to 3 liters of water daily

23. A nurse is caring for a client who has emphysema and has difficulty with moving. The client receives home health care and spends most of his day in a reclining chair. Which of the following physiological responses to prolonged immobility should the nurse expect?

Increase calcium excretion Prolonged immobility leads to breakdown of the bone tissue, which increases calcium excretion.

16. A nurse on a medical-surgical unit is performing an admission assessment of a client who has COPD with emphysema. The client reports that he has a frequent productive cough and is short of breath. The nurse should anticipate which of the following assessment findings for this client?

Increased anteroposterior diameter of the chest One of the signs and symptoms of emphysema is having a barrel chest, due to the hyper inflated lungs.

34. A nurse un an emergency department is preparing to administer theophylline by continuos intravenous (IV) infusion to a client who is experiencing an asthma attack. Which of the following actions should the nurse take?

Infuse the medication with an IV pump Theophylline should be administered slowly via infusion pump. Rapid administration may cause hypotension and death

12. A nurse is developing a plan of care for a client who has COPD. The nurse should include which of the following interventions in the plan?

Instruct the client to use pursed-lip breathing. Patient with COPD should consume a high-calorie, high-protein diet to prevent weight loss, should drink 2 to 3 liters per day and perform pursed-lip breathing.

10. A nurse is collaborating on care for a client who has COPD. Which of the following tasks should the nurse recommend be referred to an occupational therapist for assistance?

Instructing how to use kitchen tools to prepare a meal The occupational therapist works with the client to develop fine motor skills and coordination, such as improving hand strength and hand movements, focuses on self-management of ALDs, such as skills needed for eating, hygiene, and dressing. RT teaches how to measure O2 sat, nutritionist makes a diet plan, RT reaches a patient how to used pursed-lip breathing.

25. A nurse is caring for a client who has asthma and is taking fluticasone. The nurse should monitor the client for which of the following adverse effects?

Oral candidiasis Client should rinse mouth with water

24. A nurse is assessing a client who has asthma. Which of the following areas should the nurse evaluate as the most reliable indicator of central cyanosis?

Oral mucosa Nurse should first monitor client's tongue and lips for manifestations of central cyanosis.

8. A client is planning to perform nasotracheal suction for a client who has COPD and has an artificial airway. Which of the following actions should the nurse take?

Preoxygenate the client with 100% O2 for up to 3 minutes. To prevent hypoxemia, the nurse should preoxygenate the client with 100% oxygen for 30 seconds to 3 minutes prior to suctioning. Only suction up to 3 passes, when withdrawing the cath the nurse should gently rotate the cath to ensure it reaches all surface area and suction while withdrawing the cath from the trachea, NOT when inserting. Suctioning should last between 5 to 10 seconds to prevent hypoxemia.

20. A nurse is admitting a client who is having an exacerbation of his asthma. When reviewing the provider's orders, the nurse recognizes that clarification is needed for which of the following medications?

Propanolol Medications that block beta 2 (propanolol) should be clarified

13. A nurse is providing teaching to a client who has asthma and a new prescription for inhaled beclomethasone. Which of the following instructions should the nurse provide?

Rinse mouth after administration Use of glucocorticoids by metered dose inhaler can allow a fungal overgrowth in the mouth. Rinsing will lessen complication. Oral glucocorticoids should be administered with food.

5. A nurse is giving a presentation at a community center about chronic bronchitis. Which of the following information should the nurse include as effective for preventing this disorder?

Smoking cessation Smoking is a major cause of chronic bronchitis; therefore, smoking cessation is an effective preventive strategy

6. A nurse is providing discharge instructions to a client who has asthma and is about to start taking theophylline (Theo-24). The nurse should tell the client that this medication might cause which of the following adverse effects?

Tachycardia Theophylline can increase cardiac stimulation and cause tachycardia.

22. Complete following sentence by using list options: Client reports shortness of breath, vigorous bubbling noted on chest drainage system of the water seal chamber. Connections are secure. Chest tube insertion site dressing removed, air leak detected on insertion site.

The nurse should apply a non-occlusive dressing to prevent tension pneumothorax Air is heard leaking from insertion site. If an occlusive dressing is applied, air will not be able to escape causing a tension pneumothorax, therefore, the nurse should apply a non-occlusive dressing. Since air leak is noted at the insertion site, the nurse should apply a non-occlusive dressing.

21. A college health nurse interprets the peak expiratory flow rate for a student who has asthma and finds that the student is in the yellow zone of his asthma action plan. The nurse should base her actions on which of the following information?

The student should use his quick-relief inhaler (helps reverse airway obstruction) The student's asthma is not well controlled. (yellow zone indicates asthma is not controlled. Desired range is green zone; 80%) The student's peak flow is 50 to 80% of his best peak flow (appropriate % for yellow zone) The nurse should obtain a secondary expiratory flow rate (2nd flow rate should be obtained after the student uses his quick relief inhaler)

36. A nurse is providing discharge teaching to a client who has asthma and a new prescription for fluticasone/salmeterol. For which of the following adverse effects should the nurse instruct the client to report to the provider?

White coating in the mouth Adverse effect of medication is oropharyngeal candidiasis

3. A nurse is caring for a child who is experiencing status asthmaticus. Which of the following interventions is the priority for the nurse to take?

Administer a short-acting B2 agonist (SABA) When using the urgent versus non-urgent approach to client care, the nurse should determine that the priority action is to administer a nebulized high dose SABA to relieve bronchoconstriction and improve ventilation

32. A nurse is caring for a child who has asthma and a prescription of montelukast granules. Which of the following instructions should the nurse provide to the client's parent on administering the medication?

Administer the medication 2 hours before exercise. Montelukast should be given in the evening, given 2 hours before exercise, adverse effect is drowsiness, can be taken with food.

18. A nurse is assessing a client for hypoxemia during an asthma attack. Which of the following manifestations should the nurse expect?

Agitation Signs of symptoms of hypoxemia include hypertension due to increased workload of the heart to compensate, and agitation, dyspnea.

29. A nurse is caring for a school-age child who has mild persistent asthma. Which of the following is an expected finding? Select all that apply

Daytime symptoms occur more that twice a week Minor limitations occur with normal activity Peak expiratory flow PEF is greater than or equal to 80% of the predicted value

35. A nurse is caring for a toddler who has acute laryngotracheobronchitis and has been placed in a cool mist tent. Which of the following findings indicates that the treatment has been effective?

Decreased stridor Laryngotracheobronchitis, croup, is a condition that is caused by an infection of the upper airway and is characterized by a barking cough. The purpose of a cool mist is to humidify inspired air and decrease respiratory effort.

1. A nurse is auscultating the lungs of a client who has pleurisy. Which of the following adventitious breath sounds should the nurse expect to hear?

Loud, scratchy sounds Loud, scratchy sounds is caused by inflammation of the pleura. Squeaky, musical is a manifestation of bronchospasm as air whoosh through narrow airways. Popping sounds are caused by moving into deflated airways by atelectasis and pneumonia. Snoring sounds are known from ronchi due to thick, tenacious secretions.

33. A nurse is assessing a client who has a pneumothorax with a chest tube in place. For which of the following findings should the nurse notify the provider?

Movement of the trachea towards the unaffected side. A chest tube insertion can treat a spontaneous pneumothorax but can develop into tension pneumothorax, which is a medical emergency. An assessment of tracheal deviation or movement of the trachea toward the unaffected side needs to be reported to the health care provider as soon as possible.

7. A nurse is caring for a client who has asthma and developed viral pharyngitis. Which of the following findings should the nurse expect?

Negative throat culture A client who has a viral pharyngitis will have a negative throat culture. A client who has bacterial pharyngitis has a throat culture positive for beta-hemolytic streptococcus.

2. A nurse is monitoring a client who has a chest tube in place connected to wall suction due to a right-sided pneumothorax. The client complains of chest burning. Which of the following actions should the nurse take?

Reposition the client Repositioning the client is an appropriate action to relieve chest burning from the chest tube.

26. A nurse is assessing a client who has chronic bronchitis. Which of the following percussion sounds should the nurse expect?

Resonance