Exam 1: Influenza+Pneumonia+Thoracic Disorders+Asthma+COPD

Which client(s) are at increased risk to develop influenza? Select all that apply. a)42 y/o client who has been diagnosed with an autoimmune disorder b) 76 y/o client who resides in a nursing home c) 24 y/o client with allergies to penicillin and cephalosporins d) 30 y/o client who cross country skis e) 36 y/o client who is seven months pregnant

A, B, E

Which factors with the nurse consider when calculating the CURB-65 score for a client with pneumonia? Select all that apply. a) Blood Urea Nitrogen (BUN) b) O2 sat c) Blood pressure d) Presence of confusion e) respiratory rate

A, C, D, E 65 is for age 65+

A registered nurse is performing a nasopharyngeal swab for influenza. Which action by the nurse indicates poor technique? a) insert, gently rotate and immediately remove swab b) insert swab straight back along floor of nasal pasage c)support clients head ot reduce tendency to pull away during procedure d) place swab into transport container after collection

A: insert, gently rotate and immediately remove swab

The Nurse requires information collected by a client diagnosed with asthma. Which findings would the client's asthma is being well controlled? Select all that apply. a)Nighttime awakening accouring two or less times/week b)NO interference with normal ADLs c)symptoms occurring two or less days/week d)use of SABAs two or less days/week e)peak flow meter greater than 80% of personal best

All of the Above

The nurse obtains the following assessment data on an older patient who has influenza. Which information will be most important for the nurse to communicate to the health care provider? a. Fever of 100.4° F (38° C) b. Diffuse crackles in the lungs c. Sore throat and frequent cough d. Myalgia and persistent headache

B crackles indicate patient may be developing pneumonia

A client diagnosed with influenza A is prescribed oseltamivir (Tamiflu) five days after developing symptoms. Which statement is the most appropriate for the nurse to make when teaching the client about this medication? a)"This medication will alleviate symptoms within 24 hours of taking the first dose" b)"This medication may not be effective because of the delay in starting treatment" c)"It is safe to take this medication and receive influenza vaccine at the same time" d)"Do no take this medication if you have a lactose food allergy"

B:"This medication may not be effective because of the delay in starting treatment"

A client diagnosed with bacterial pneumonia has course, thick sputum. Which action should the nurse plan to promote airway clearance? a)Assist client to splint chest when coughing b) encourage client to wear nasal O2 cannula c) Teach pursed lipped breathing technique d) Restrict oral fluids throughout the day

a)Assist client to splint chest when coughing

The nurse reviews the MAR for a client having an acute asthma attack. Which medication should the nurse administer first? a)albuterol 2.5 mg/nebulizer b)salmeterol 50 mcg/dry-powder c)ipratropium 2 puffs/metered dose inhaler d)methylprednisolone 60 mg IV

a)albuterol 2.5 mg/nebulizer

A client with severe COPD tell the nurse "I wish I were dead! Im just a burden on everybody." Based on this information, which nursing diagnoses is most appropriate? a)chronic low self esteem r/t physical dependence b)complicated grieving r/t expectation of death c)ineffective coping r/t unknown outcome of illness d)deficient knowledge r/t lack of education about COPD

a)chronic low self esteem r/t physical dependence

A client diagnosed with a right-sided pneumothorax has continuous bubbling in the suction-control of a water chamber suction collection device. Which action by the nurse is most important? a)continue to monitor collection device b)adjust dial on wall regulator c)notify surgeon of possible hemopneumothorax d)document the presence of an intermittent air leak

a)continue to monitor collection device

A client diagnosed with COPD has poor gas exchange. Which action by the nurse would support the clients ventilation? a)encourage the client to sit up at the bedside in a chair and lean forward b)have the client rest in bed with head elevated 15-30 degrees c)place the client in trandelenburg position with pillows behind the head d)ask the client to rest in bed in a high fowlers position with the knees flexed

a)encourage the client to sit up at the bedside in a chair and lean forward

Postural drainage with percussion and vibration is ordered twice daily for a client diagnosed with COPD. Which intervention should the nurse include in the plan of care? a)give prescribed albuterol before therapy b)perform percussion before assisting the client to the drainage position c)schedule the procedure one hour after the client eats d)maintain the client in the lateral position for 20 minutes

a)give prescribed albuterol before therapy

A client diagnosed with COPD is receiving 35% oxygen via a Venturi mask. Which action by the nurse is appropriate for the care if this equipment? a)keep air entertainment ports clean and unobstructed b)wash and dry under the mask every 8 hours c)drain moisture condensation from the corrugated tubing every hour d)give a high enough flow rate to keep the bag from collapsing

a)keep air entertainment ports clean and unobstructed

A client is admitted to the ED for acute asthma exacerbation. EMTs report the client is tachycardic, tachypnic, and inspiratory and expiratory wheezing. On assessment the nurse notes that there is no wheezing but the client is still struggling to breathe. Which action should the nurse implement first? a)notify HCP b)encourage cough and deep breathing c)administer IV methylprednisolone d)document changes in respiratory status

a)notify HCP

When assessing a client who has just arrived after a car crash, the ED nurse notes tachycardia and absent breath sounds over the right lung. Which intervention is most appropriate for the nurse to take? a)prepare for chest tube insertion b)Instruct the client on the use of IS c)prep for emergency thoracentesis d)administer short-acting bronchodilator

a)prepare for chest tube insertion

The nurse monitors a client in the emergency department with a chest tube for a hemopneumothorax. Which assessment finding would most concern the nurse? a)Subcutaneous emphysema at the insertion site b) 400 ml of blood noted one hour after insertion c) reports of pain with deep inhalation d) a large air leak in the water-seal chamber

b) 400 ml of blood noted one hour after insertion

A client diagnosed with pneumonia has a fever of 101.4 F, a nonproductive cough, and an O2 sat of 88%. The client reports weakness, fatigue, and needs assistance to get out of bed. Which nursing diagnosis should the nurse assign as priority? a)Hyperthermia r/t infectious illness b) Impaired gas exchange r/t respiratory congestion c)Ineffective airway clearance r/t thick secretions d) Impaired transfer ability r/t weakness

b) Impaired gas exchange r/t respiratory congestion

The nurse prepares to administer pneumococcal conjugate vaccine (Prevnar 13) to a 72 year old client. Which criteria would prevent the client from receiving the vaccine? a) currently hospitalized with heart failure but prognosis is improving b) a temp of 101.2 F in the last 12 hours c) A client on warfarin with an International Normalised Ratio (INR) of 2.1 seconds d) currently hospitalized on the surgical unit recovering from an appendectomy

b) a temp of 101.2 F in the last 12 hours

The nurse assesses the chest of a client diagnosed with consolidated pneumococcal pneumonia. Which finding would the nurse expect to find? a)Pleural friction rub b)Increased tactile fremitius c)dry, nonproductive cough d)hyperresonance on percussion

b)Increased tactile fremitius

The nurse completes an admission assessment on a client diagnosed with asthma. Which information from their home medication list indicates a need for a change in therapy? a)client is prescribed albuterol and theophyline b)client is prescribed albuterol and salmeterol c)client is prescribed albuterol and montelukast d)client is prescribed albuterol and budesonide

b)client is prescribed albuterol and salmeterol

The nurse receives change of shift report on the following clients diagnosed with COPD. Which client should the nurse assess first? a)client with productive cough of thick, green mucus b)client with a respiratory rate of 38 breaths/minute c)client with loud expiratory wheezes d)client with bilateral lower peripheral edema

b)client with a respiratory rate of 38 breaths/minute

A client hospitalized with COPD is being discharged home on oxygen therapy. Which instruction should the nurse include in the discharge teaching? a)avoid use of a microwave oven when using your supplemental oxygen b)oxygen use can improve your quality of life if used more than 15 hours per day c)as long as you do not smoke, it is safe to go into areas where other are smoking cigarettes or cigars d)apply vaseline or petroleum jelly on lips and nose to prevent dryness and irritation

b)oxygen use can improve your quality of life if used more than 15 hours per day

The client develops a left tension pneumothorax after insertion of a central venous catheter. Which will the nurse expect to find? a)bradycardia b)right tracheal deviation c)hypotension d)client reports pain with exhalation

b)right tracheal deviation

A client newly diagnosed with persistent asthma with recurring attacks is being discharged. Which topic should the nurse anticipate including in the discharge teaching? a)side effects of sustained-release theophylline b)self administration of inhaled corticosteriods c)use of long acting B-adrenergic medications d)complications associated with oxygen therapy

b)self administration of inhaled corticosteriods

The home health nurse is visiting a client diagnosed with COPD. Which nursing action is appropriate for a nursing diagnosis of impaired breathing pattern r/t anxiety? a)suggest the use of the over-the-counter sedative medication b)teach the client how to use pursed lip breathing c)titrate oxygen to keep saturation at least 90% d)discuss a high-protein, high calorie diet with client

b)teach the client how to use pursed lip breathing

Which instruction should the nurse include in the exercise teaching plan for a client diagnosed with chronic COPD? a)it is not recommend that clients diagnosed with COPD perform physical exercise of any kind b)walking combined with strength training are the best ways to strengthen muscles and improve activity endurance c)if it takes longer than two minutes to return to baseline you need to proceed at a slower pace during the next exercise period d)avoid upper body strength training exercises as this will make your breathing more difficult and increase SOB

b)walking combined with strength training are the best ways to strengthen muscles and improve activity endurance

A client diagnosed with asthma is scheduled for spirometry testing. Which action should the nurse take to prepare the client for this procedure? a)administer oral corticosteroids two hours before procedure b)withhold bronchodilators for 6-12 hours before examination c)give rescue medication immediately after testing d)ensure that the client has been NPO for several hours before the test.

b)withhold bronchodilators for 6-12 hours before examination

A client has just been admitted with bacterial pneumonia and sepsis. The client is unable to provide a sputum sample. Which action should the nurse implement first? a)administer acetaminophen (Tylenol) 650 mg oral tabs b) Request respiratory therapy administer a nebulizer treatment c) administer ciprofloxacin (Cipro) 400 mg IV d) send the client to radiology for a chest x-ray

c) administer ciprofloxacin (Cipro) 400 mg IV

The nurse teaches a client diagnosed with pneumonia. Which statement by the client indicates a good understanding of the discharge instructions? a)"I will call my HCP if I still feel tired after 1 week" b)"I will cancel my follow up chest x-ray appointment if I feel better next week" c)"I will continue to do deep breathing and coughing at home" d)"I will schedule separate appointments for the pneumonia and flu vaccines"

c)"I will continue to do deep breathing and coughing at home"

A client is suspected of having influenza. Which assessment data obtained by the nurse would support this diagnosis? a) mild, localized muscle aches b)temp of 99.1 F c)Abrupt onset of symptoms d)purulent nasal drainage

c)Abrupt onset of symptoms

Which information should the nurse include in teaching plan for a client newly diagnosed with chronic obstructive pulmonary disease (COPD) a)Pulmonary rehab programs offer very little benefit b)if you quit smoking, your lungs will heal and you will no longer have COPD c)a bronchodilator with metered dose inhaler should be readily available d)pneumococcal vaccination is contraindicated for clients with lung disease

c)a bronchodilator with metered dose inhaler should be readily available

An hour after a left pleural chest tube is inserted for a hemopneumothorax, a client reports incisional pain at a "7" (based on a 0 to 10). Breath sounds are decreased on the left side, and the pleural drainage system has 100 ml of bloody drainage with a positive air leak. Which action should the nurse take? a)Milk the chest tube to remove clots b)Check tube patency by clamping tubing c)administer prescribed pain medication d)drain the blood from the collection chamber

c)administer prescribed pain medication

A client diagnosed with a plural effusion is scheduled for a thoracentesis. Which action should the nurse take to prepare the client for procedure? a)obtain a collection device to hold three liters of pleural fluid b)remind the client not to eat or drink anything for 6 hours c)position the client sitting up on the side of the bed d)start a peripheral IV line to administer sedatives

c)position the client sitting up on the side of the bed

The nurse teaches a client diagnosed with asthma about pursed-lip breathing. Which action by the client would indicate to the the nurse that further teaching is needed? a)inhales slowly through the nose b)ratio inhalation of 1:3 c)puffs up their cheeks while exhaling d)practices by blowing through straw

c)puffs up their cheeks while exhaling

A client diagnosed with COPD has course crackles throughout the lung fields and a chronic, nonproductive cough. Which nursing intervention will be most effective? a)change the oxygen flow rate to the highest prescribed rate b)teach the client about consistent use of inhaled corticosteriods c)teach the client to use the flutter airway clearance device d)reinforce the ongoing use of pursed lip breathing techniques

c)teach the client to use the flutter airway clearance device

The nurse teaches a client diagnosed with asthma about peak flow meter use. Which action by the client indicates that teaching was successful? a)take montelukast for peak flows in the red zone b)inhales rapidly through the peak flow meter mouth piece c)use an albuterol inhaler for peak flows in the yellow zone d)calls the healthcare provider when the peak flow is in the green zone

c)use an albuterol inhaler for peak flows in the yellow zone

A client having an acute asthma attack is in a state of panic. Which intervention should the nurse implement? a)Use IV sedation b)Use music or television as a distraction c)utilize talk down approach d)lay the client down in a supine position

c)utilize talk down approach

A client with RLL pneumonia has been treated with IV antibiotics for three days. Which assessment data obtained by the nurse indicates that the treatment is effective? a)Broncial breath sounds are heard at the right base b) increased tactile fremitus is palpable over the right chest c) the client coughs up small amounts of green mucus d) the clients WBC count is 9000/uL

d) the clients WBC count is 9000/uL

The nurse provides dietary teaching to a client diagnosed with COPD who has a low body mass index. Which client statement indicates that the teaching has been effective? a)I will drink lots of fluids with meal b)I will decrease my intake of meat and poultry c)I will exercise for 15 minutes before meals d)I can have ice cream as a snack everyday

d)I can have ice cream as a snack everyday

The clinic nurse makes a follow-up telephone call to a client diagnosed with asthma. The client reports having a baseline peak flow reading of 600 L/min, and the current peak flow is 420 L/min. Which action should the nurse take first? a)Tell the client to go to the hospital ED b)Question the client about use of the prescribed inhaled corticosteriods c)Ask about recent exposure to any new allergens or asthma triggers d)Instruct the client to use the prescribed albuterol

d)Instruct the client to use the prescribed albuterol

The nurse is caring for client who has just has a thoracentesis. Which assessment information obtained by the nurse is a priority to communicate to the HCP? a)Pain level at a 5/10 when breathing in b)respiratory rate of 24 when lying flat c)BP of 135/90 d)O2 sat of 88% on room air

d)O2 sat of 88% on room air

The charge nurse observes a new nurse care for a client with a wet chest tube system. Suction is set at -20 cm of H2O. An air leak is present. Which action by the new nurse requires immediate intervention by the charge nurse? a)instruct client to use incentive spirometery q 1 hour while awake b)ambulate client to bathroom while maintaining continuous wall suction c)increases wall suction until gentle bubbling is present in suction control chamber d)elevates drainage system above insertion site to check drainage

d)elevates drainage system above insertion site to check drainage

The nurse cares for a client diagnosed with a pleural effusion. Documentation states, "Chest tube -20 cm of pressure. Tidaling present. No air leak noted." Which is the best interpretation of this statement? a)a leak is present around the chest tube insertion site b)the affected lung has fully expanded c)the water seal chamber needs sterile water added d)fluid is still present in the pleural space

d)fluid is still present in the pleural space

What assessment finding in a client is prescribed omalizumab subQ for asthma would need to be reported immediately to the healthcare provider? a)pain at injection site b)RR @ 24 breaths/min c)peak flow reading 75% of normal d)flushing/hives

d)flushing/hives

The nurse in the ED receives arterial blood gas results for four recently admitted clients diagnosed with obstructive pulmonary disease. Which result requires rapid action by the nurse? a)pH 7.34, PaCO2 33mmhg, PaO2 80 mmhg b)pH 7.48, PaCO2 30mmhg, PaO2 65mmhg c)pH 7.31, PaCO2 58 and PaO2 64 mmhg d)pH 7.28, PaCO2 50mmhg, PaO2 58mmhg

d)pH 7.28, PaCO2 50mmhg, PaO2 58mmhg

The nurse is caring for a client diagnosed with cor pulmonale. The nurse should monitor the client for which expected finding? a)chest pain b)finger clubbing c)elevated temperature d)peripheral edema

d)peripheral edema

A client is admitted to the ED with an open stab wound to the left chest. Which action should the nurse take? a)keep the head of the bed flat b)cover the wound tightly with an occlusive dressing c)position the client so that the left chest is dependent d)tape the nonporous dressing on three sides over the wound

d)tape the nonporous dressing on three sides over the wound Prevents air from going in but allows air to move out. Complete coverage will cause a tension pneumo. The HOB should be elevated at 45 degrees.

Which information will the nurse include in the asthma teaching plan for a client being discharged? a)use mometasone when you first start experiencing asthma symptoms b)inhale slowly and deeply when using fluticasone c)hold your breath for two to three seconds after using ciclesonide metered-dosed inhaler d)tremors are an expected side effect with albuterol

d)tremors are an expected side effect with albuterol