Adult Theory - Respiratory

D

A 50-year-old man vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors s for gastritis, the nurse will ask the patient about: A. The amount of saturated fat in the diet B. Any family history of gastric or colon cancer C. A history of a large recent weight gain or loss D. Use of NSAIDs

B

A 44-year-old man admitted with peptic ulcer disease has a nasogastric tube in place. When the patient develops sudden severe upper abdominal pain, diaphoresis, and firm abdomen, which action should the nurse take? A. Irrigate the NG tube. B. Check the vital signs. C. Give the ordered antacid. D. Elevate the foot of the bed.

C - GERD is exasperated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime

A 46-year-old female with gastroesophageal reflux disease is experiencing increasing discomfort. Which patient statement indicates that additional teaching about GERD is needed? A. I take antacids between meals and at bedtime each night B. I sleep with the head of the bed elevated on 4 inch blocks C. I eat small meals during the day and have a bedtime snack D. I quit smoking several years ago, but I still chew a lot of gum

B

A 49-year-old man has been admitted with hypotension and dehydrated after three days and nausea and vomiting. Which order from the healthcare provider will the nurse implement first? A. Insert a NG tube. B. Infuse normal saline at 250 mL/hr. C. Administer IV ondanestron. D. Provide oral care with moistened swabs.

A

A 50-year-old patient who underwent a gastroduodenostomy earlier today complains of increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red NG drainage in the last hour. The highest priority action by the nurse is to: A. Contact the surgeon B. Irrigate the NG tube C. Monitor the NG drainage D. Administer the prescribed morphine

C - because the patient's nausea is associated with severe pain, it is likely that it is precipitated by stress and pain. The best treatment will be to provide adequate pain medication before dressing changes. The nurse should avoid doing painful procedures close to meal times, but nausea/vomiting that occur at other times should also be addressed.

A 53-year-old male patient with a deep partial thickness burns from a chemical spill in the workplace experiences severe pain followed by nausea during dressing changes. Which action will be most useful in decreasing the patient nausea? A. Keep the patient in PO for two hours before and after dressing changes B. Avoid performing dressing changes close to the patient meal times C. Administer the prescribed morphine sulfate before a dressing change D. Give the ordered prochlorperazine before dressing change

C - Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia.

A 68-year-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of GERD, the nurse will plan to do frequent assessments of the patients: A. Apical pulse B. Bowel sounds C. Breath sounds D. Abdominal girth

A -- A humidifier will help liquefy secretions and promote their expectoration. Sleeping on pillows facilitates breathing; it does not relieve chest congestion. Nonproductive coughing should be avoided because it is irritating and exhausting. Deep breathing and coughing at night will not help relieve early morning congestion.

A client with COPD reports chest congestion, especially upon wakening in the morning. The nurse should suggest that the client: a. Use a humidifier in the bedroom. b. Sleep with 2 or more pillows. c. Cough regularly even if the cough does not produce sputum. d. Cough and deep breathe each night before going to sleep.

C -- A peak flow meter measures the peak expiratory flow rate, the maximum flow of air that can be forcefully exhaled in one second; this monitors the pulmonary status of a client with asthma. The peak flow measurement should be done daily in the morning before the administration of medication or when experiencing dyspnea. The client should be standing or sitting upright. Placing the mouthpiece between the lips and in front of the teeth before starting the procedure will interfere with an accurate test; the mouthpiece should be in the mouth between the teeth with the lips creating a seal around the mouthpiece.

A client with asthma is being taught how to use a peak flow meter to monitor how well the asthma is being controlled. What. should the nurse instruct the client to do? a. Perform the procedure once in the morning and once at night. b. Move the trunk to an upright position and then exhale while bending over. c. Inhale completely and then blow out as hard and as fast as possible through the mouthpiece. d. Place the mouthpiece between the lips and in front of the teeth before starting the procedure.

B -- The high PaCO2 level causes flushing due to vasodilation. The client also becomes drowsy and lethargic because carbon dioxide has a depressant effect on the central nervous system. Cyanosis is a sign of hypoxia. Irritability and anxiety are not common with a PaCO2 level of 65 mm Hg but are associated with hypoxia.

A client's arterial blood gas values are as follows: pH, 7.31; PaO2, 80 mm Hg; PaCO2, 65 mm Hg; HCO3-, 36 mEq/L. The nurse should assess the client for: a. cyanosis b. flushed skin c. irritability d. anxiety

B - Kussmaul respirations (deep and rapid) are a compensatory mechanism for metabolic acidosis.

A diabetic patient's arterial blood has results are pH 7.28, PaCO2 34 mmHg, PaO2 85 mmHg, HCO3 18 mEq/L. The nurse would expect which finding? A. Intercostal retractions B. Kussmaul respirations C. Low oxygen saturation D. Decreased venous O2 pressure

B - Famotidine is administered to prevent the development of physiologic stress ulcers, which are associated with a major physiologic insult such as a massive trauma.

A family member of a 28-year-old patient who has suffered massive abdominal trauma in an automobile accident as the nurse why the patient is receiving famotidine. The nurse will explain that the medication will: A. Decrease nausea and vomiting B. Inhibit development of stress ulcers C. Lower the risk for H. Pylori infection D. Prevent aspiration of gastric contents

B, C

A home health nurse is teaching a client who has active tuberculosis and is following a medication regimen that includes a combination of isoniazid, rifampin, pyrazinamide, and ethambutol. Which of the following client statements indicate understanding? Select all that apply. A. I can substitute one medication for another if I run out because they all fight infection. B. I will wash my hands each time I cough. C. I will wear a mask when I am in a public area. D. I am glad I do not have to have any more sputum specimens. E. I do not need to worry where I go once I start taking my medications.

B, C, E

A nurse in the ED is caring for a client who is experiencing an acute asthma attack. Which of the following assessments indicates that the respiratory status is declining? Select all that apply. a. SaO2 95% b. Wheezing c. retraction of sternal muscles d. pink mucous membranes e. tachycardia

D -- Understanding the disorder and the details of care are essential for the client to be self-sufficient. Although teaching is important, a perceived understanding of the need for specific interventions must be expressed before there is a readiness for learning. Referring to a support group is premature; this may be done eventually. Although ensuring a speedy return to classes is important, involving the college should be the client's decision.

A nurse in the health clinic is counseling a college student who recently was diagnosed with asthma. On what aspect of care should the nurse focus? a. teaching how to make a room allergy-free b. referring to a support group for individuals with asthma c. arranging with the college to ensure a speedy return to classes d. evaluating whether the necessary lifestyle changes are understood

B

A nurse is assessing a client who has a history of asthma. Which of the following factors should the nurse identify as a risk for asthma? a. sex b. environmental allergies c. alcohol use d. history of diabetes

B - Dullness characterizes pneumonia. Resonance characterizes chronic bronchitis. It is a loud, low pitched sound of long duration. Tympany characterizes pneumothorax. Flatness characterizes pleural effusion.

A nurse is assessing a client who has chronic bronchitis. Which of the following percussion sounds should the nurse expect? A. Dullness B. Resonance C. Tympany D. Flatness

D -- Administer a beta-2 agonist, which causes dilation of the bronchioles to relieve wheezing and open the airways. (Bronchodilators: beta agonists, anticholinergics, methylxanthines)

A nurse is caring for a client 2 hr after admission. The client has an SaO2 of 91%, exhibits audible wheezes, and is using accessory muscles when breathing. Which of the following classes of medications should the nurse expect to administer? a. antibiotic b. beta-blocker c. antiviral d. beta-2 agonist

D

A nurse is caring for a client who has 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? A. Maintaining a semi Fowler's position as often as possible B. Administering oxygen via nasal cannula at 2 L per minute C. Helping the client select a low salt diet D. Encouraging the client to drink 2 to 3 L of water daily

C

A nurse is caring for a client who has a new diagnosis of tuberculosis and has been placed on a multi-medication regimen. Which of the following instructions should the nurse give the client related to ethambutol? A. Your urine can turn a dark orange. B. Watch for a change in the sclera of your eyes. C. Watch for any changes in vision. D. Take vitamin B six daily.

B - The nurse should clamp the clients chest tube only when replacing the drainage system or when checking for air leaks. The nurse should keep the drainage system lower than the clients chest to facilitate drainage from the chest cavity. The nurse should keep the tubing as straight as possible, without any kinks or dependent loops. This can impair the function of the chest tube. Upright positioning allows optimal long expansion. The nurse should elevate the head of the clients bed at least 30°.

A nurse is caring for a client who has a newly inserted chest drainage system with a water seal. Which of the following actions should the nurse take? A. Clamp the tube when the client is ambulating B. Keep the collection device below the level of the clients chest C. Coil the tubes carefully to prevent kinking D. Lay the client flat to avoid leaks in the tubing

B - Constant, gentle bubbling in the suction control chamber indicates that the suction is functioning. Continuous or excessive bubbling in the water seal chamber indicates an air leak between the water seal and the client's chest. However, gentle bubbling on forceful exhalation or coughing is normal. For the first few hours after surgery, the drainage is likely to be bloody, transitioning to blood tinged after that. Since the nurse doesn't empty a disposable system but replaces it when it is full, bloody drainage in the collection chamber at 12 hours is an expected finding. Fluid in the water seal chamber should fluctuate with inspiration and expiration, a process called titling, because pressure in the pleural space changes during respiration.

A nurse is caring for a client who is 12 hours post operative and has a chest tube to a disposable water seal drainage system with suction. The nurse should intervene for which of the following observations? A. Constant bubbling in the suction control chamber B. Continuous bubbling in the water seal chamber C. Bloody drainage in the collection chamber D. Fluid level fluctuations in the water seal chamber

A

A nurse is discharging a client who has COPD. The client is concerned about not being able to leave the house due to the need for staying on continuous oxygen. Which of the following responses should the nurse make? a. "There are portable oxygen delivery systems that you can take with you." b. "When you go out, you can remove the oxygen and then reapply it when you get home." c. "You probably will not be able to go out as much as you used to." d. "Home health services will come to you so you will not need to get out."

D

A nurse is instructing a client on the use of an incentive spirometer. Which of the following statements by the client indicates an understanding of the teaching? a. "I will place the adapter on my finger to read my blood oxygen saturation level." b. "I will lie on my back with my knees bent." c. "I will rest my hand over my abdomen to create resistance." d. "I will take in a deep breath and hold it before exhaling."

C

A nurse is planning to instruct a client on how to perform pursed-lip breathing. Which of the following statements should the nurse include? a. "Take quick breaths upon inhalation." b. "Place your hand over your stomach." c. "Take a deep breath in through your nose." d. "Puff your cheeks upon exhalation."

C

A nurse is preparing to administer a new prescription for isoniazid to a light-skinned client who has TB. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication? A. You might notice yellowing of your skin B. You might experience pain in your joints C. You might notice tingling of your hands D. You might experience a loss of appetite

4 mL

A nurse is preparing to administer albuterol syrup 1.6 mg PO tid. Available is albuterol 2 mg per 5 mL. How many milliliters should the nurse administer per dose?

A, C, E

A nurse is preparing to administer an initial dose of prednisone to a client who has COPD. The nurse should monitor for which of the following adverse effects of this medication? Select all that apply. a. hypokalemia b. tachycardia c. fluid retention d. nausea e. black, tarry stools

B - The nurse should instruct the client to eat small, frequent meals to conserve energy and increase nutrient intake. The nurse should instruct the client to limit low nutrient liquids during meals to prevent early satiety and increase intake of nutrient dense food. The nurse should instruct the client to increase protein and calories to increase muscle mass and energy. The nurse should instruct the client to use a bronchodilator 30 minutes before eating to reduce the risk for bronchospasm and increase nutrient intake.

A nurse is providing dietary teaching for a client who has chronic obstructive pulmonary disease. Which of the following instructions should the nurse include? A. Eat three large meals each day. B. Limit water intake with meals. C. Reduce protein intake. D. Use a bronchodilator one hour before eating.

C -- Bronchodilators, such as albuterol, can cause tachycardia. Anti-inflammatory agents can cause mouth sores, decrease the immune response, and cause hyperglycemia.

A nurse is providing discharge teaching to a client who has COPD and a new prescription for albuterol. Which of the following statements by the client indicates an understanding of the teaching? a. "This medication can increase my blood sugar levels." b. "This medication can decrease my immune response." c. "I can have an increase in my HR while taking this medication." d. "I can have mouth sores while taking this medication."

C -- Taking prednisone on an empty stomach can cause GI distress. The client should monitor the mouth for canker sores. This medication can cause bleeding of the gums and soreness in the mouth.

A nurse is providing discharge teaching to a client who has a new prescription for prednisone for asthma. Which of the following client statements indicates understanding? a. "I will decrease my fluid intake while taking this medication." b. "I will expect to have black, tarry stools." c. "I will take this medication with meals." d. "I will monitor for weight loss while on this medication."

A, C, D, E

A nurse is providing information about tuberculosis to a group of clients at a local community center. Which of the following manifestations should the nurse include? Select all that apply. A. Persistent cough B. Weight gain C. Fatigue D. Night sweats E. Purulent sputum

B -- A bronchodilator can prevent asthma attacks from occurring.

A nurse is reinforcing teaching with a client on the purpose of taking a bronchodilator. Which of the following client statements indicates understanding? a. "This medication can decrease my immune response." b. "I take this medication to prevent asthma attacks." c. "I need to take this medication with food." d. "This medication has a slow onset to treat my symptoms."

B - The nurse should instruct the client who is taking a short acting beta two agonist, such as albuterol, to check her heart rate before each dose. Fluticasone can cause palpitations, tachycardia, angina, and dysrhythmias. The nurse should instruct the client to inspect her mouth daily. This is a corticosteroid, which reduces the clients immunity and increases the risk for infection, such as Candida albicans.

A nurse is teaching a client who has COPD and is to start using fluticasone by MDI twice daily. Which of the following instructions should the nurse include? A. Check your heart rate before each dose B. Inspect your mouth for lesions daily C. Use this medication to relieve an acute attack D. Skip the morning dose if you do not have any symptoms

A, B, C, D, E, F Inhaling deeply and then exhaling completely is the first step. Next, the client should place her lips firmly around the mouthpiece to direct the spray to the airways, then breathe in deeply over 2 to 3 seconds while pushing down on the canister. This slow and deep inhalation directs the medication down into the lower respiratory track. Holding her breath for 10 seconds is next; it allows time for absorption of the medication. Then, pursed lip breathing keeps the small airways open during slow exhalation. And finally, waiting 60 seconds between puffs allows for deeper penetration of the medication into the respiratory tract.

A nurse is teaching a client who has asthma how to use a meter dose inhaler. The nurse identifies the sequence of steps the client should follow: A. Inhale deeply and then exhale completely B. Place her lips firmly around the mouthpiece C. Breathe in deeply over 2 to 3 seconds while pushing down on the canister D. Hold her breath for 10 seconds E. Exhale slowly through pursed lips F. Wait 60 seconds between each puff

C - clients who have emphysema have a greater than usual nutritional requirements for calories and proteins and often need nutritional supplements between meals. The client should first inhale slowly through the nose, then exhale slowly through pursed lips. The client is at risk for respiratory infections. Therefore, the client should avoid crowds and should get an annual vaccination against influenza. The client should practice abdominal breathing exercises daily while lying on his back with his knees flexed. The client should focus on using the diaphragm to achieve maximum inhalation and to slow his respiratory rate.

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? A. I will inhale slowly through pursed lips to help me breathe better B. I will avoid getting a flu shot C. I will follow a daily diet high in calories and protein D. I will lie on my stomach to practice abdominal breathing every day

D - The client should take isoniazid on an empty stomach and avoid antacids, as food and antacids can decrease absorption of the medication. The client should return to the clinic every 2 to 4 weeks to provide sputum for a sputum culture. The client is no longer infectious after three consecutive negative sputum cultures. The client sputum cultures should be negative after three months of multi drug therapy, at which time he is no longer contagious. A client who has tuberculosis usually takes pyrazinamide for the first two months of therapy and can shorten the entire course of therapy to six months. The nurse should instruct the client to drink at least 240 mL of fluid when taking the medication and to protect himself from the sun with cotton clothing and sunscreen.

A nurse is teaching a client who has tuberculosis and is to start medication therapy with isoniazid, rifampin, and pyrazinamide. Which of the following instructions should the nurse include? A. Take isoniazid with an antacid. B. Provide a sputum specimen every two weeks to the clinic for testing. C. Expect your sputum cultures to be negative after six months of therapy. D. Drink at least 8 ounces of water when you take the pyrazinamide tablet.

B - The client who has tuberculosis needs to continue taking the medication regimen for 6 to 12 months. The client who has tuberculosis needs to provide sputum samples every 2 to 4 weeks to monitor the effectiveness of the medication.

A nurse is teaching a client who has tuberculosis. Which of the following statements should the nurse include? A. You will need to continue to take the multi medication regimen for four months. B. You will need to provide sputum samples every four weeks to monitor the effectiveness of the medication. C. You'll need to remain hospitalized for treatment. D. You will need to wear a mask at all times.

A -- Paradoxic chest movement indicates that the patient may have flail chest, which can severely compromise gas exchange and can rapidly lead to hypoxemia.

A patient experiences a chest wall contusion as a result of being struck in the chest with a baseball bat. The ED nurse would be most concerned if which finding is observed during the initial assessment? a. paradoxic chest movement b. complaint of chest wall pain c. heart rate of 110 beats/min d. large bruised area on the chest

C - cough suppressants are frequently prescribed for acute bronchitis. Because most acute bronchitis is viral in origin, antibiotics are not prescribed unless there are system symptoms.

A patient has acute bronchitis with a non-productive cough and wheezes. Which topic should the nurse plan to include in the teaching plan? A. Purpose of antibiotic therapy B. Ways to limit oral fluid intake C. Appropriate use of cough suppressants D. Safety concerns with home oxygen therapy

D -- Long-term oxygen therapy in the home will not be considered until the oxygen saturation is less than or equal to 88% and the patient has signs of tissue hypoxia, such as cor pulmonale, erythrocytosis, or impaired mental status. PaO2 less than 55 mm Hg will also allow home oxygen therapy to be considered.

A patient has been receiving oxygen per nasal cannula while hospitalized for COPD. The patient asks the nurse whether oxygen use will be needed at home. What is the most appropriate response by the nurse? a. "Long-term home oxygen therapy should be used to prevent respiratory failure." b. "Oxygen will not be needed until or unless you are in the terminal stages of this disease." c. "Long-term home oxygen therapy should be used to prevent heart problems related to COPD." d. "You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia."

B -- Initiating antibiotic therapy rapidly is essential, but it is important that the cultures be obtained before antibiotic administration.

A patient has just been admitted with probable bacterial pneumonia and sepsis. Which order should the nurse implement first? a. chest x-ray via stretcher b. blood cultures from 2 sites c. ciprofloxacin 400 mg IV d. acetaminophen rectal suppository

A - Spiral CT scans are the most commonly used test to diagnose pulmonary emboli, and contrast media may be given IV.

A patient is admitted to the emergency department complaining of sudden onset shortness of breath and is diagnosed with a possible pulmonary embolus. How should the nurse prepare the patient for diagnostic testing to confirm the diagnosis? A. Start an IV so contrast media may be given B. Ensure that the patient has been NPO for at least 6 hrs C. Inform radiology that radioactive glucose preparation is needed D. Instruct the patient to undress to the waist and remove any metal objects

B

A patient is admitted to the emergency department with an open stab wound to the left chest. What is the first action that the nurse should take? A. Position the patient so that the left chest is dependent B. Tape a non-porous dressing on three sides over the chest wound C. Cover the sucking chest wound firmly with an occlusive dressing D. Keep the head of the patient's bed at no more than 30° elevation

D

A patient is admitted with active TB. The nurse should question a HCP's order to discontinue airborne precautions unless which assessment finding is documented? A. Chest X-ray shows no upper lobe infiltrates B. TB meds have been taken for 6 months C. Mantoux testing shows an induration of 10 mm D. Three sputum smears for acid-fast bacilli are negative

D - negative sputum smears indicate that Mycobacterium tuberculosis is not present in the sputum, and the patient cannot transmit the bacteria by the airborne route.

A patient is admitted with active tuberculosis. The nurse should question a healthcare providers order to discontinue airborne precautions unless which assessment finding is documented? A. Chest x-ray shows no upper lobe infiltrates B. TB medications have been taken for six months C. Mantoux testing shows an Induration of 10 mm D. Three sputum smears for acid-fast bacilli are negative

A, C, D, E

A patient is concerned that he may have asthma. Of the symptoms that he describes to the nurse, which ones suggest asthma or risk factors for asthma? Select all that apply. a. allergic rhinitis b. prolonged inhalation c. cough, especially at night d. gastric reflux or heartburn e. history of chronic sinusitis

C - drug interactions can occur between the antiretrovirals used to treat HIV infection and the medication is used to treat TB. The other data are expected in a patient with HIV and TB.

A patient is diagnosed with both HIV and active tuberculosis disease. Which information obtained by the nurse is most important to communicate to the healthcare provider? A. The Mantoux test had an induration of 7 mm. B. The chest x-ray showed infiltrates in the lower lobes. C. The patient is being treated with antiretrovirals for HIV infection. D. The patient has a cough that is productive of blood tinged mucus.

C - drug interactions can occur between the antiretrovirals used to treat the HIV infection and the medication is used to treat tuberculosis

A patient is diagnosed with both HIV and tuberculosis. Which information obtained by the nurse is most important to communicate to the healthcare provider? A. The tuberculosis skin test had an induration of 7 mm B. The chest x-ray showed infiltrates in the lower lobes C. The patient is being treated with antiretrovirals for HIV infection D. The patient has a call that is productive of blood tend mucus

B, E Because the contrast media is iodine-based and may cause dehydration and decreased renal blood flow, asking about iodine allergies and monitoring renal function before the CT are necessary.

A patient is scheduled for a commuted tomography (CT) of the chest with contrast media. Which assessment findings should the nurse immediately report to the healthcare provider? Select all that apply. A. Patient is claustrophobic B. Patient is allergic to shellfish C. Patient recently used a bronchodilator inhaler D. Patient is not able to remove a wedding band E. Blood urea nitrogen (BUN) and serum creatinine levels are elevated

D

A patient who has a history of COPD was hospitalized for increasing shortness of breath and chronic hypoxemia (SaO2 levels of 89% to 90%). In planning for discharge, which action by the nurse will be most effective in improving compliance with the discharge teaching? A. Start giving the patient discharge teaching on the day of admission B. Have the patient repeat the instructions immediately after teaching C. Accomplish the patient teaching just before the scheduled discharge D. Arrange for the patient's caregiver to be present during the teaching

C -- Continuous bubbling is expected in the suction-control chamber and indicates that the suction-control chamber is connected to suction.

A patient who has a right-sided chest tube following a thoracotomy has continuous bubbling in the suction-control chamber of the collection device. Which action by the nurse is most appropriate? a. document the presence of a large air leak b. notify the surgeon of a possible pneumothorax c. take no further action with the collection data d. adjust the dial on the wall regulator to decrease suction

D -- Early initiation of antibiotic therapy has been demonstrated to reduce mortality.

A patient who has just been admitted with community-acquired pneumococcal pneumonia has a temp of 101.6 with a frequent cough and is complaining of severe pleuritic chest pain. Which prescribed med should the nurse give first? a. codeine b. guaifenesin c. acetaminophen d. piperaciliin/tazobactum

C, D, E

A patient with TB has been admitted to the hospital and is placed on airborne precautions and in an isolation room. What should the nurse teach the patient? Select all that apply. A. Expect routine TV testing to evaluate the infection. B. No visitors will be allowed while in airborne isolation. C. Adherence to precautions includes coughing into a paper tissue. D. Take all medications for full length of time to prevent multi drug resistant TB. E. Where a standard isolation mask if leaving the airborne infection isolation room.

B - risk for aspiration and maintaining an open airway is the priority. Because a local anesthetic is used to suppress the gag/cough reflexes during bronchoscopy, the nurse should monitor for the return of these reflexes before allowing the patient to take oral fluids or foods.

A patient with a chronic cough has a bronchoscopy. After the procedure, which intervention by the nurse is most appropriate? A. Elevate the head of the bed to 80 to 90° B. Keep the patient NPO until the gag reflex returns C. Place on bed rest for at least four hours after procedure D. Notify the healthcare provider about blood tinged mucus

B

A patient with a chronic cough has a bronchoscopy. After the procedure, which intervention by the nurse is most appropriate? A. Elevate the head of the bed to 80 to 90° B. Keep the patient NPO until the gag reflex returns C. Place on bedrest for at least four hours after bronchoscopy D. Notify the healthcare provider about blood tinged mucus

B -- When the patient is sitting up, fluid accumulates in the pleural space at the lung bases and can more easily be located and removed.

A patient with a pleural effusion is scheduled for a thoracentesis. Which action should the nurse take to prepare the patient for the procedure? a. start a peripheral IV line to administer the necessary sedative drugs b. position the patient sitting upright on the edge of the bed and leaning forward c. obtain a large collection device to hold 2-3 L of pleural fluid at one time d. remove the water pitcher and remind the patient not to eat or drink anything for 6 hrs

D

A patient with a possible pulmonary embolism complaint of chest pain and difficulty breathing. The nurse find a heart rate of one 42 bpm, blood pressure of 100/60, respirations of 42 breaths per minute. Which action should the nurse take first? A. Administer anticoagulant drug therapy B. Notify the patient's healthcare provider C. Prepare patient for spiral CT scan D. Elevate the head of the bed to a semi Fowlers position

A - because iodine-based contrast media is used during a spiral CT, the patient may need to have the CT scan without contrast or be premedicated before injection of the contrast media.

A patient with acute dyspnea is scheduled for a spiral CT scan. Which information obtained by the nurse is a priority to communicate to the healthcare provider before the CT scan? A. Allergy to shellfish B. Apical pulse of 104 C. Respiratory rate of 30 D. Oxygen saturation of 90%

B - when a patient has severe respiratory distress, only information pertinent to the current episode is obtained in a more thorough assessment is deferred until later.

A patient with acute shortness of breath is admitted to the hospital. Which action should the nurse take during the initial assessment of the patient? A. Ask the patient to lie down to complete a full physical assessment B. Briefly ask specific questions about this episode of respiratory distress C. Complete the admission database to check for allergies before treatment D. Delay the physical assessment to first complete pulmonary function test

B - When a patient has severe respiratory distress, only information pertinent to the current episode is obtained, and a more thorough assessment is deferred until later.

A patient with acute shortness of breath is admitted to the hospital. Which action should the nurse take during the initial assessment of this patient? A. Ask the patient to lie down to complete a full physical assessment B. Briefly ask specific questions about this episode of respiratory distress C. Complete the admission database to check for allergies before treatment D. Delay the physical assessment to first complete pulmonary function test

A

A patient with bacterial pneumonia has rhonchi and thick sputum. What is the nurse's most appropriate action to promote airway clearance? A. Assist the patient to splint the chest when coughing B. Teach the patient about the need for fluid restrictions C. Encourage the patient to wear the nasal oxygen cannula D. Instruct the patient on the pursed lip breathing technique

D

A patient with pneumonia has a fever of 101.4, a nonproductive cough, and an oxygen saturation of 88%. The patient complains of weakness, fatigue, and needs assistance to get out of bed. Which nursing diagnosis should the nurse assign as the highest priority? A. Hyperthermia related to infectious disease B. Impaired transfer ability related to weakness C. Ineffective airway clearance related to thick secretions D. Impaired gas exchange related to respiratory congestion

C

A patient with right lower lobe pneumonia has been treated with IV antibiotics for 3 days. Which assessment data obtained by the nurse indicates that the treatment has been effective? A. Bronchial breath sounds are heard at the right base B. The patient coughs up small amounts of green mucus C. The patient's WBC count in 9,000 D. Increased tactile fremitus is palpable over the right chest.

C - Orange colored body secretions are a side effect of this drug. The patient does not have to stop taking the medication. The findings are not indicative of an allergic reaction. Alterations in red green color discrimination commonly occurs when taking ethambutol.

A person who is taking rifampin for tuberculosis cause the clinic and reports having orange discolored urine and tears. Which is the best response by the nurse? A. Ask if the patient is experiencing shortness of breath, hives, or itching. B. Ask the patient about any visual abnormalities such as red green color discrimination. C. Explain that orange discolored urine and tears are normal while taking this medication. D. Advise the patient to stop the drug and report the symptoms to the healthcare provider.

B - because the cough and gag are decreased after this procedure, this patient should be assessed for airway patency.

After the nurse has received change of shift report, which patient should the nurse assess first? A. A patient with pneumonia who has crackles in the right lung base B. A patient with possible lung cancer who has just returned after bronchoscopy C. A patient with hemoptysis and a 16 mm induration with TB skin testing D. A patient with COPD and pulmonary function testing that indicates low forced vital capacity

B - The first action should be to determine whether the patient has been compliant with drug therapy because negative sputum smears would be expected if the TB bacillus is susceptible to the medication and if the medications have been taken correctly. Assessment is the first step in the nursing process. Depending on whether the patient has been compliant or not, different medications or directly observed therapy may be indicated.

After two months of tuberculosis treatment with isoniazid, rifampin, pyrazinamide, and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli. Which action should the nurse take next? A. Teach about treatment for drug resistant TB treatment. B. Ask the patient whether medication's have been taken as directed. C. Schedule the patient for directly observed therapy three times weekly. D. Discuss with the healthcare provider the need for the patient to use an injectable antibiotic.

B

An Experienced nurse instructs a new nurse about how to care for a patient with Dyspnea a caused by pulmonary fungal infection. Which action by the new nurse indicates a need for further teaching? A. Listening to the patient's lung sound several times during the shift B. Placing the patient on droplet precautions and in a private hospital room C. Increasing the oxygen flow rate to keep the oxygen sat above 90% D. Monitoring patient serology results to identify the specific infecting organism

D - directly observed therapy is the most effective means for ensuring compliance with the treatment regimen, and arranging a daily meal will help ensure that the patient is available to receive the medication.

An alcoholic and homeless patient is diagnosed with active tuberculosis. Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen? A. Arrange for a friend to administer the medication on schedule B. Give the patient written instructions about how to take the medication C. Teach the patient about the high risk for infecting others unless treatment is followed D. Arrange for a daily noon meal at a community center where the drug will be administered

D -- The patient is unlikely to take deep breaths or cough until the pain level is lower. A chest tube output of 100 mL is not unusual in the first hour after thoracotomy and would not require milking the chest tube. An air leak is expected in the initial postoperative period after thoracotomy.

An hour after a thoracotomy, a patient complains of incisional pain at a level 7 and has decreased left-sided breath sounds. The pleural drainage system has 100 mL of bloody drainage and a large air leak. Which action is best for the nurse to take next? a. milk the chest tube gently to remove any clots b. clamp the chest tube momentarily to check for the origin of the air leak c. assist the patient to deep breathe, cough, and use the incentive spirometer d. set up the PCA and administer the loading dose of morphine

A

An older patient is receiving standard multidrug therapy for TB. The nurse should notify the HCP provider if the patient exhibits which finding? A. Yellow tinged skin B. Orange colored sputum C. Thickening of fingernails D. Difficulty hearing high pitched voices

A - patients taking multi drug therapy for tuberculosis must be monitored for hepatotoxicity.

An order patient is receiving standard multi drug therapy for tuberculosis. The nurse should notify the healthcare provider if the patient exhibits which finding? A. Yellow tinged skin B. Orange colored sputum C. Thickening of the fingernails D. Difficulty hearing high-pitched voices

C - The nurse is considered to have a latent TB infection and should be treated with iron NH daily for 6 to 9 months. The four-drug therapy would be appropriate if the nurse had active TB. TV skin testing is not done for individuals who have already had a positive skin test. The vaccine is not used in the United States for TB and would not be helpful for this individual, who already has a TB infection.

Employee health test results revealed a tuberculosis skin test of 16 mm in duration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB. Which information should the occupational health nurse plan to teach the staff nurse? A. Standard four-drug therapy for TB B. Need for annual repeat TB skin testing C. Uses and side effects of isoniazid D. Bacille Calmette Gurin vaccine

A -- Exercise can improve cardiovascular fitness and help the client tolerate periods of hypoxia better, perhaps reducing the risk of heart attack. Most exercise has little effect on respiratory muscle strength, and these clients can't tolerate the type of exercise necessary to do this. Exercise won't reduce the number of acute attacks. In some instances, exercise may be contraindicated, and the client should check with his physician before starting any exercise program.

Exercise has which of the following effects on clients with asthma, chronic bronchitis, and emphysema? a. It enhances cardiovascular fitness. b. It improves respiratory muscle strength. c. It reduces the number of acute attacks. d. It worsens respiratory function and is discouraged.

B

Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine? A. It absorbs the gastric acid. B. It decrease gastric acid secretion. C. It constructs the blood vessels near the ulcer. D. It covers the ulcer with a protective material.

A

One oc quotation of a patient's lungs, the nurse hears low pitched, bubbling sounds during inhalation in the lower third of both lungs. How should the nurse document this finding? A. Inspiratory crackles at the bases B. Expiratory wheezes in both lungs C. Abnormal lung sounds in the apices of both lungs D. Plural friction rub in the right and left lower lobes

D -- Humidification of the environment helps to prevent thickened secretions. Liquefied secretions are easier to expectorate. Measures to prevent infection are essential; however, infections are impossible to eliminate. Exhaling requires less energy than inhaling; therefore, movements that use energy should be done during exhalation. The use of abdominal muscles rather than thoracic muscles improves the client's breathing.

Rehabilitation of a client with chronic obstructive pulmonary disease (COPD) involves strategies to decrease hospital admissions and to live a more active life. What should the nurse teach the client to do? a. initiate activities to eliminate infections b. inhale during movements that require energy c. implement breathing that uses the thoracic muscles d. incorporate humidification into the home environment

D

The HCP prescribes antacids and sucralfate for treatment of a patient's peptic ulcer. The nurse will teach the patient to take: A. Sucralfate at bedtime and antacids before each meal B. Sucralfate and antacids together 30 mins before meals C. Antacids 30 mins before each dose of Sucralfate is taken D. Antacids after meals and Sucralfate 30 mins before meals

C

The HCP writes an order for bacteriologic testing for a patient who has a positive TB skin test. Which action should the nurse take? A. Teach about the reason for the blood tests. B. Schedule an appointment for a chest X-ray. C. Teach about the need to get sputum specimens for 2-3 consecutive days. D. Instruct the patient to expectorate three specimens as soon as possible.

C -- Decreased oxygen to the vital centers in the brain results in restlessness and confusion. Cyanosis is a late sign of respiratory failure. Tachycardia, not bradycardia, will occur as a compensatory mechanism to help increase oxygen to body cells. Distended neck veins occur with fluid volume excess (e.g., pulmonary edema).

The arterial blood gases of a client with chronic obstructive pulmonary disease (COPD) deteriorate, and respiratory failure is impending. For which clinical indicator should the nurse assess first? a. cyanosis b. bradycardia c. mental confusion d. distended neck veins

A, B, C, D The therapeutic range for serum theophylline is 10 to 20 mcg/mL (55.5 to 111 μmol/L). At higher levels, the client will experience signs of toxicity such as nausea, vomiting, seizure, and insomnia.

The client with chronic obstructive pulmonary disease (COPD) is taking theophylline. The nurse should instruct the client to report which of the following signs of theophylline toxicity? Select all that apply. a. nausea b. vomiting c. seizures d. insomnia e. vision changes

C - sputum specimens are obtained on 2 to 3 consecutive days for testing of M. Tuberculosis. The patient should not provide all the specimens at once. Blood cultures are not used for tuberculosis testing. A chest x-ray is not bacteriologic testing. Although the findings on chest x-ray exam are important, it is not possible to make a diagnosis of tuberculosis solely based on chest x-ray findings because other diseases can mimic the appearance of tuberculosis.

The healthcare provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test. Which action should the nurse take? A. Teach about the reason for the blood tests. B. Schedule an appointment for a chest x-ray. C. Teach about the need to get sputum specimens for 2 to 3 consecutive days. D. Instruct the patient to expectorate three specimens as soon as possible.

C

The major advantage of a Venturi mask is that it can: a. deliver up to 80% O2 b. provide continuous 100% humidity c. deliver a precise concentration of oxygen d. be used while a patient eats and sleeps

A

The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided HF. Which assessment would best evaluate the effectiveness of the therapies? a. observe for distended neck veins b. auscultate for crackles in the lungs c. palpate for heaves or thrills over the heart d. review hemoglobin and hematocrit values

D - The increased need for a rapid acting bronchodilator should alert the patient that acute attack may be eminent and that a change in therapy may be needed. The patient should be taught to contact a healthcare provider if this occurs.

The nurse admit a patient who has a diagnosis of an acute asthma attack. Which statement indicates that the patient may need teaching regarding medication use? A. I have not had any acute asthma attacks during the last year. B. I became short of breath an hour before coming to the hospital. C. I have been taking Tylenol 650 mg every six hours for chest wall pain. D. I have been using my albuterol inhaler more frequently over the last four days.

D

The nurse analyzes the results of a patient's arterial blood gases. Which finding would require immediate action? A. Bicarbonate level is 31 mEq/L B. Arterial oxygen saturation is 92% C. Partial pressure of CO2 in arterial blood is 31 mmHg D. Partial pressure of oxygen in arterial blood is 59 mmHg

A

The nurse assess the chest of a patient with pneumococcal pneumonia. Which finding would the nurse expect? A. Increased tactile fremitus B. Dry, nonproductive cough C. Hyper resonance to percussion D. A grating sound on auscultation

A - The increase in respiratory rate indicates respiratory distress and a need for rapid interventions such as administration of oxygen or medications.

The nurse assesses a patient with COPD who has been admitted with increasing dyspnea over the last three days. Which finding is most important for the nurse to report to the healthcare provider? A. Respirations are 36 breaths per minute. B. Anterior posterior chest ratio is 1 to 1 C. Lung expansion is decreased bilaterally D. Hyperresonance to percussion is present

A

The nurse cares for a patient who has just had a thoracentesis. Which assessment finding obtained by the nurse is a priority to communicate to the HCP? a. oxygen sat is 88% b. BP 145/90 mmHg c. RR is 22 breaths/min when lying flat d. pain level is 5 with a deep breath

D

The nurse completes discharge teaching for a patient who has had a lung transplant. The nurse evaluates that the teaching has been effective if the patient makes which statement? a. I will make an appointment to see the doctor every year. b. I will stop taking the prednisone if I experience a dry cough. c. I will not worry if I feel a little short of breath with exercise. d. I will call the HCP right away if I develop a fever.

A -- Albuterol is a β2-agonist that can sometimes cause adverse cardiovascular effects. These would include tachycardia and angina. A pulse rate of 72 indicates that the patient did not experience tachycardia as an adverse effect.

The nurse determines that the patient is not experiencing adverse effects of albuterol after noting which patient vital sign? a. pulse rate of 72/min b. temp of 98.4 F c. oxygen saturation 96% d. RR 18/min

B

The nurse develops a plan of care to prevent aspiration in a high-risk patient. Which nursing action will be most effective? A. Turn and reposition immobile patients at least every 2 hrs. B. Place patients with altered consciousness in side-lying positions. C. Monitor for respiratory symptoms in patients who are immunosuppressive D. Insert NG tube for feedings for patients with swallowing problems.

D

The nurse explaining esomeprazole to a patient with recurring heartburn describes that the medication: A. Reduces gastroesophageal reflux by increasing the rate of gastric emptying B. Neutralizes stomach acid and provides relief of symptoms in a few minutes C. Coats and protects the lining of the stomach and esophagus from gastric acid D. Treats gastroesophageal reflux disease by decreasing stomach acid production

A -- The primary problem during an exacerbation of asthma is narrowing of the airway and subsequent diminished air exchange. As the airways begin to dilate, wheezing gets louder because of better air exchange. Vesicular breath sounds will increase with improved respiratory status. After a severe asthma exacerbation, the cough may be productive and stringy. Coughing after aerosol bronchodilators may indicate a problem with the inhaler or its use.

The nurse is caring for a patient with an acute exacerbation of asthma. Following initial treatment, what finding indicates to the nurse that the patient's respiratory status is improving? a. wheezing becomes louder b. cough becomes nonproductive c. vesicular breath sounds decrease d. aerosol bronchodilators stimulate coughing

D - patients who have received the vaccine will have a positive skin test. Another method for screening will need to be used in determining whether the patient has a TB infection

The nurse is performing tuberculosis skin test in a clinic that has mini patient to immigrated to the United States. Which question is most important for the nurse to ask before the skin test? A. Is there any family history of TB? B. How long have you lived in the United States? C. Do you take any over-the-counter medications? D. Have you received the vaccine for TB?

B -- The large amount of blood may indicate that the patient is in danger of developing hypovolemia shock. An air leak would be expected immediately after chest tube placement for a pneumothorax. Initially, brisk bubbling of air occurs in this chamber when a pneumothorax is evacuated. The pain should be treated but is not as urgent a concern as the possibility of continued hemorrhage. Subcutaneous emphysema should be monitored but is not unusual in a patient with pneumothorax. A small amount of subcutaneous air is harmless and will be reabsorbed.

The nurse monitors a patient after chest tube placement for a hemopneumothorax. The nurse is most concerned if which assessment finding is observed? a. a large air leak in the water-seal chamber b. 400 mL of blood in the collection chamber c. complaint of pain with each deep inspiration d. subcutaneous emphysema at the insertion site

C

The nurse notes that a patient has incisional pain, a poor cough effort, and scattered rhonchi after thoracotomy. Which action should the nurse take first? A. Assist the patient to sit upright in the chair B. Split the patient's chest during coughing C. Medicate the patient with prescribed morphine D. Observe the patient use the incentive spirometer

C - Listening only during inspiration indicates the student needs a review of respiratory assessment skills. At each placement of the stethoscope, listen to at least one cycle of inspiration and expiration. During chest auscultation, instruct the patient to breathe slowly and a little deeper than normal through the mouth. Asko Tatian should proceed from the long apices to the bases, comparing opposite areas of the chest, unless the patient is in respiratory distress or will tire easily.

The nurse observes a student who is listening to a patient's lungs who is having no problems with breathing. Which action by the student indicates a need to review respiratory assessment skills? A. The student starts at the apices of the lungs and moves to the bases. B. The student compares breath sounds from side to side avoiding bony areas C. The student place is the stethoscope over the posterior chest and listens during inspiration D. The student instructs the patient to breathe slowly and a little more deeply than normal through the mouth

D

The nurse palpates the posterior chest while the patient says 99 and notes absent fremitus. Which action should the nurse take next? A. Palpate the anterior chest and observe for barrel chest B. Encourage the patient to turn, cough, and deep breath C. Review the chest x-ray report for evidence of pneumonia D. Auscultate anterior and posterior breath sounds bilaterally

B

The nurse planned healthcare for a community with a large number of recent immigrants from Vietnam. Which intervention is the most important for the nurse to implement? A. Hepatitis testing B. Tuberculosis screening C. Contraceptive teaching D. Colonoscopy information

D - The upright position with the arm supported increases lung expansion, allows fluid to collect at the lung bases, and expand the intercostal space so that access to the pleural space is easier.

The nurse prepares a patient with a left-sided pleural effusion for thoracentesis. How should the nurse position the patient? A. Supine with the head of the bed elevated 30° B. In a high Fowler's position with the left arm extended C. On the right side with the left arm extended above the head D. Sitting up ride with the arm supported on an over bed table

B

The nurse provides discharge instructions to a patient who was hospitalized for pneumonia. Which statement, if made by the patient, indicates a good understanding of the instructions? A. I will call the doctor if I still feel tired after a week. B. I will continue to do the deep breathing and coughing exercises at home. C. I will schedule two appointments for the pneumonia and influenza vaccines. D. I will cancel my chest X-ray appointment if I am feeling better in a couple weeks.

B

The nurse receives change of shift report on the following four patients. Which patient should the nurse assess first? A. A 23-year-old patient with cystic fibrosis who has pulmonary function testing scheduled B. A 46-year-old patient on bedrest who is complaining of sudden onset of shortness of breath C. A 77-year-old patient with tuberculosis who has four anti-tubercular medications due in 15 minutes D. A 35-year-old patient who is admitted the previous day with pneumonia and a temperature of 100. 2°F

B -- Clients with chronic COPD have CO2 retention and the respiratory drive is stimulated when the PO2 decreases. The heart rate, respiratory rate, and blood pressure should be evaluated to determine if the client is hemodynamically stable. Symptoms, such as dyspnea, should also be assessed. Oxygen supplementation, if indicated, should be titrated upward in small increments. There is no indication that the client is experiencing respiratory distress requiring intubation.

The nurse reviews an arterial blood gas report for a client with chronic obstructive pulmonary disease (COPD). The results are: pH 7.35; PCO2 62 (8.25 kPa); PO2 70 (9.31 kPa) (34 mmol/L); HCO3 34. The nurse should first: a. Apply a 100% nonrebreather mask. b. Assess the vital signs. c. Reposition the patient. d. Prepare for intubation.

B -- The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people who have the flu or a cold and should get yearly flu vaccinations. Environmental exposure to toxins or heavy particulate matter can trigger asthma attacks; however, far fewer asthmatics are exposed to such toxins than are exposed to viruses. Cigarette smoke can also trigger asthma attacks, but to a lesser extent than viral respiratory infections. Some asthmatic attacks are triggered by exercising in cold weather.

The nurse should teach the client with asthma that which of the following is one of the most common precipitating factors of an acute asthma attack? a. occupational exposure to toxins b. viral respiratory infections c. exposure to cigarette smoke d. exercising in cold temperatures

D -- Increasing dyspnea on exertion indicates that the client may be experiencing complications of COPD. Therefore, the nurse should notify the physician. Extracting promises from clients is not an outcome criterion. Pain is not a common symptom of COPD. Clients with COPD use low-flow oxygen supplementation (1 to 2 L/min) to avoid suppressing the respiratory drive, which, for these clients, is stimulated by hypoxia.

Which of the following indicates that the client with chronic obstructive pulmonary disease (COPD) who has been discharged to home understands the care plan? a. The client promises to do pursed-lip breathing at home. b. The client states actions to reduce pain. c. The client will use oxygen via a nasal cannula at 5 L/min. d. The client agrees to call the physician if dyspnea on exertion increases.

D -- It is not within the LPN scope to change oxygen devices based on analysis of lab results. It is within the scope of practice of the RN to assess, teach, and evaluate. The LPN provides care for stable patients and may adjust oxygen flow rates depending on desired oxygen saturation levels of stable patients. The UAP may obtain oxygen saturation levels, assist patients with comfort adjustment of oxygen devices, and report changes in patient's level of consciousness or difficulty breathing.

The nurse supervises a team including another registered nurse (RN), a licensed practical/vocational nurse (LPN/LVN), and unlicensed assistive personnel (UAP) on a medical unit. The team is caring for many patients with respiratory problems. In what situation should the nurse intervene with teaching for a team member? a. LPN/LVN obtained a pulse oximetry reading of 94% but did not report it. b. RN taught the patient about home oxygen safety in preparation for discharge. c. UAP reports to the nurse that the patient is complaining of difficulty breathing. d. LPN/LVN changed the type of oxygen device based on arterial blood gas results.

B -- Fluticasone (Flovent HFA) may cause oral candidiasis (thrush). The patient should rinse the mouth with water or mouthwash after use or use a spacer device to prevent oral fungal infections. Fluticasone is an inhaled corticosteroid, and it may take 2 weeks of regular use for effects to be evident. This medication is not recommended for an acute asthma attack.

The nurse teaches a 33-year-old male patient with asthma how to administer fluticasone (Flovent HFA) by metered-dose inhaler (MDI). Which statement by the patient to the nurse indicates correct understanding of the instructions? a. "I should not use a spacer device with this inhaler." b. "I will rinse my mouth each time after I use this inhaler." c. "I will feel my breathing improve over the next 2-3 hrs." d. "I should use this inhaler immediately if I have trouble breathing."

C - for pulmonary function testing, the patient should inhale deeply and exhale as long, hard, and fast as possible.

The nurse teaches a patient about pulmonary function testing. Which statement, if made by the patient, indicates teaching was effective? A. I will use my inhaler right before the test B. I will not eat or drink anything eight hours before the test C. I should inhale deeply and blow out as hard as I can during the test D. My blood pressure and pulse will be checked every 15 minutes after the test

B - teach the patient how to minimize exposure to close contacts and household members. Homes should be well ventilated, especially the areas where the infected person spends a lot of time. While still infectious, the patient should sleep alone, spend as much time as possible outdoors, and minimize time in congregate settings or on public transportations.

The nurse teaches a patient about the transmission of pulmonary tuberculosis. Which statement, if made by the patient, indicates that teaching was effective? A. I will avoid being outdoors whenever possible B. My husband will be sleeping in the guest bedroom C. I will take the bus instead of driving to visit my friends D. I will keep the windows closed at home to contain the germs

A

The nurse will anticipate preparing a 71-year-old female patient who is vomiting coffee ground emesis for: A. Endoscopy B. Angiography C. Barium studies D. Gastric analysis

D - because diagnostic testing for heartburn that is probably caused by GERD is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD

The nurse will anticipate teaching a patient experiencing frequent heartburn about: A. A barium swallow B. Radionucleotide tests C. Endoscopy procedures D. Proton pump inhibitors

B -- Corticosteroids such as prednisone can lead to weight gain. For this reason, it is important to monitor the patient's daily weight. The drug should not affect the apical pulse, bowel sounds, or deep tendon reflexes.

The nurse, who has administered a first dose of oral prednisone to a patient with asthma, writes on the care plan to begin monitoring for which patient parameters? a. apical pulse b. daily weight c. bowel sounds d. deep tendon reflexes

A, E Breathing exercises may assist the patient during rest and activity (e.g., lifting, walking, stair climbing) by decreasing dyspnea, improving oxygenation, and slowing the respiratory rate. The main type of breathing exercise commonly taught is pursed-lip breathing. Walking or other endurance exercises (e.g., cycling) combined with strength training is probably the best intervention to strengthen muscles and improve the endurance of a patient with chronic obstructive pulmonary disease (COPD).

The plan of care for the patient with COPD should include: (Select all that apply.) a. exercise such as walking b. high flow rate of O2 administration c. low-dose chronic oral corticosteroid therapy d. use of peak flow meter to monitor the progression of COPD e. breathing exercises, such as pursed-lip breathing that focuses on exhalation

B

The registered nurse caring for an HIV positive patient admitted with tuberculosis can delegate which action to unlicensed assistive personnel? A. Teach the patient about how to use tissues to dispose of respiratory secretions B. Stock the patient's room with all the necessary personal protective equipment C. Interview the patient to obtain the names of family members and close contacts D. Tell the patient's family members the reason for the use of airborne precautions

B

What nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy? A. Notify doctor about bloody NG drainage B. Elevate the HOB to at least 30 degrees C. Reposition the NG tube if drainage stops D. Start oral fluids when the patient has active bowel sounds

D -- The patient's history and absent breath sounds suggest a right-sided pneumothorax or hemothorax, which will require treatment with chest tube and drainage.

When assessing a patient who has just arrived after an automobile accident, the ED nurse notes tachycardia and absent breath sounds over the right lung. For which intervention will the nurse prepare the patient? a. emergency pericardiocentesis b. stabilization of the chest wall with tape c. administration of an inhaled bronchodilator d. insertion of a chest tube with a chest drainage system

D - crackles in the lower half of the lungs indicate that the patient may have an acute problem such as heart failure. The nurse should immediately accomplish further assessments, such as oxygen saturation, and notify the healthcare provider.

When assessing the respiratory system of an older patient, which finding indicates that the nurse should take immediate action? A. Weak cough effort B. Barrel shaped chest C. Dry mucous membranes D. Bilateral crackles at lung bases

B - A HEPA mask, rather than a standard surgical mask, should be used when entering the patient's room because this mask can filter out 100% of small airborne particles.

When caring for a patient who is hospitalized with active tuberculosis, the nurse observes a student nurse who is assigned to take care of a patient. Which action, if performed by the student nurse, would require an intervention by the nurse? A. The patient is offered a tissue from the box at the bedside B. A surgical facemask is applied before visiting the patient C. A snack is brought to the patient from the unit refrigerator D. Handwashing is performed before entering the patient's room

Because the patient with COPD needs to use greater energy to breathe, there is often decreased oral intake because of dyspnea. A full stomach also impairs the ability of the diaphragm to descend during inspiration, thus interfering with the work of breathing. For these reasons, the patient with COPD should eat six small meals per day taking in a high-calorie, high-protein diet, with non-protein calories divided evenly between fat and carbohydrate. The other interventions will not increase the patient's caloric intake.

When caring for a patient with chronic obstructive pulmonary disease (COPD), the nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after noting a weight loss of 30 lb. Which intervention should the nurse add to the plan of care for this patient? a. order fruits and fruit juices to be offered between meals b. order a high-calorie, high-protein diet with six small meals a day c. teach the patient to use frozen meals at home that can be microwaved d. provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet

A -- A client with COPD is at high risk for development of respiratory infections. COPD is slowly progressive; therefore, maintaining current status and establishing a goal that the client will require less supplemental oxygen are unrealistic expectations. Treatment may slow progression of the disease, but permanent improvement is highly unlikely.

When developing a discharge plan to manage the care of a client with chronic obstructive pulmonary disease (COPD), the nurse should advise the client to expect to: a. develop respiratory infections easily b. maintain current status c. require less supplemental oxygen d. show permanent improvement

B -- In COPD there are structural changes that include hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowing of small airways, and loss of lung elasticity. An autosomal recessive deficiency of antitrypsin may cause COPD. Not all patients with COPD have excess mucus production by the increased number of goblet cells.

When planning teaching for the patient with COPD, the nurse understands that what causes the manifestations of the disease? a. an overproduction of the antiprotease alpha-1 anti-trypsin b. hyperinflation of alveoli and destruction of alveolar walls c. hypertrophy and hyperplasia of goblet cells in the bronchi d. collapse and hypoventilation of the terminal respiratory unit

C

Which action by the nurse will be most effective in decreasing the spread of pertussis in a community setting? A. Providing supportive care to a patient diagnosed with pertussis B. Teaching family members about the need for careful handwashing C. Teaching patients about the need for adult pertussis immunizations D. Encouraging patients to complete the prescribe course of antibiotics

B - labeling of specimens is within the scope of practice of a UAP.

Which action is appropriate for the nurse to delegate to unlicensed assistive personnel? A. Listen to a patient's lung sounds for wheezes or rhonchi B. Label specimens obtained during percutaneous lung biopsy C. Instruct a patient about how to use home spirometry testing D. Measure induration at the site of a patient's intradermal skin test

A

Which action should the nurse in the emergency department anticipate for a 23-year-old patient who has had several episodes of bloody diarrhea? A. Obtain a stool specimen for culture B. Administer anti diarrheal medication C. Provide teaching about antibiotic therapy D. Teach about adverse effects of acetaminophen

D

Which assessment should the nurse perform first for a patient who just vomited bright red blood? A. Measuring the quantity of emesis B. Palpating the abdomen for distention C. Auscultating the chest for breath sounds D. Taking the BP and pulse

A, C, D

Which findings indicate that a patient is developing status asthmaticus? Select all that apply. a. PEFR less than 300 L/min b. positive sputum culture c. unable to speak in complete sentences d. lack of response to conventional treatment e. chest x-ray shows hyperinflated lungs and a flattened diaphragm

D

Which guideline should the nurse include when teaching a patient how to use a metered-dose inhaler? a. After activating the MDI, breathe in as quickly as you can. b. Estimate the amount of remaining medicine in the MDI by floating the canister in water. c. Disassemble the plastic canister from the inhaler and rinse both pieces under running water every week. d. To determine how long the canister will last, divide the total number of puffs in the canister by the puffs needed per day.

B

Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease? A. You will need to remain on a bland diet B. Avoid foods that cause pain after you eat them C. High protein foods are less likely to cause you pain D. You should avoid eating any raw fruits and vegetables

B - Clear cool liquids are usually the first foods started after a patient has been nauseated. Acidic foods such as orange juice, very hot foods, and coffee are poorly tolerated when patients have been nauseated.

Which item should the nurse offered to the patient who has to restart oral intake after being NPO due to nausea and vomiting? A. Glass of orange juice B. Dish of lemon gelatin C. Cup of coffee with cream D. Bowl of hot chicken broth

B

Which mediations will the nurse teach the patient about whose peptic ulcer disease is associated with Helicobacter pylori? A. Sucralfate, nystatin, and bismuth B. Amoxicillin, clarithromycin, and omeprazole C. Famotidine, magnesium hydroxide, and pantoprazole D. Metoclopromide, bethanechol, and promethazine

C, D

Which medications would be most appropriate to administer to a patient experiencing an acute asthma attack? Select all that apply. a. montelukast b. inhaled hypertonic saline c. albuterol d. ipratropium e. salmeterol

A

Which statement indicates the patient with asthma requires further teaching about self-care? a. "I use my corticosteroid inhaler when I feel short of breath." b. "I get a flu shot every year and see my HCP if I have an upper respiratory tract infection." c. "I use my inhaler before I visit my aunt who has a cat, but I only visit for a few minutes because of my allergies." d. "I walk 30 minutes every day but sometimes I have to use my bronchodilator inhaler before walking to prevent me from getting short of breath."