Med surg 3

A client who is at risk for pneumonia, has been ordered influenza vaccine. Which statement from the nurse best explains the rationale for this vaccine?

"Viruses, like influenza, are the most common cause of pneumonia."

The nurse is teaching a client with asthma how to administer the necessary medication in a time of crisis. The nurse determines the session is successful when the client correctly chooses which medications are to be used as a rescue inhaler? Select all that apply.

-Albuterol -Metaproterenol

An elderly client is prescribed an antihistamine. Which finding on the ongoing assessment should the nurse prioritize? Select all that apply.

-Dry mouth -Sedation -Hypertension

A client presents to the clinic with a cough that is getting worse. The client reports having used over-the-counter dextromethorphan. Which findings on assessment should the nurse prioritize after noting the client is prescribed phenelzine? Select all that apply.

-Fever -Coma

A client is prescribed an inhaled corticosteroid. The nurse would instruct the client about which as a possible adverse reaction? Select all that apply.

-Fungal infection -pharyngeal irritation

What are the conditions that make up Virchow's Triad? Select all that apply.

-Hypercoagilability -Venostasis -Disruption of the vessel lining

A client is taking metoprolol 50 mg one tablet twice daily begins taking over-the counter pseudoephedrine. The nurse would assess for which potential reaction? Select all that apply.

-Hypertensive episode -Bradycardic episode

The nurse is an occupational health nurse is presenting a workshop on laryngeal cancer. What risk factors would the nurse be sure to include in the workshop? Select all that apply.

-Industrial pollutants -Alchohol -Tobacco

The nurse is mentoring a new graduate nurse, caring for a client with a new trachestomy. The new graduate nurse asks what the complications of tracheostomy are. What would the nurse respond? Select all that apply.

-Infection -Aspiration -Injury to the laryngeal nerve

A nurs is preparing a teaching plan for a client and caregiver on the proper use of a dry powder inhaler. Which instructions will the nurse include in this teaching? Select all that apply.

-Inhale quickly -Hold breath for 10 seconds

A client is administered a bronchodilator during an acute asthma attack. As the client's condition improves the nurse will prioritize which assessments? Select all that apply.

-Lung sounds -Intake -Accessory muscle use -Output

The nurse is preparing to administer a codeine-containing antitussive to a client. The nurse will exercise caution if which additional situation is noted in the client's medical history? Select all that apply.

-Pregnancy -Convulsive disorder -Prostatic hyperytrophy

The nurse is teaching a client how to properly use a peak flow meter. The nurse determines the session is successful when the client correctly explains which steps? Select all that apply.

-Stands upright to allow the best inhalation possible -Make sure lips are sealed tightly around the mouthpiece -Make sure indicator is at lowest level on scale

After teaching a group of nursing students about xanthine derivatives, the instructor determines that the teaching was successful when the students correctly state which result of using these medications? Select all that apply.

-Stimulate the CNS to promote bronchodilation -Cause flushing

A nurse is preparing to administer an antitussive to a client. Which assessment will the nurse prioritize in the preadministration assessment? Select all that apply.

-Temperature -Type of cough -Sputum presence

The nurse is preparing to administer an anti-asthmatic drug to a client. The nurse determines the drug should be held and the health care provider notified after noting which respiratory rate on assessment.

10 breaths/min

The nurse is caring for a client who is in respiratory distress. The physician orders arterial blood gases (ABGs) to determine various factors related to blood oxygenation. What site can ABGs be obtained from?

A puncture at the radial pulse

The nurse working in the radiology clinic is assisting with a pulmonary angiography. The nurse knows that when monitoring after a pulmonary angiography, what should the physician be notified about?

Absent distal pulses

The ICU nurse is caring for a cleint who was admitted with a diagnosis of smoke inhalation. The nurse knows that this client is at increased risk for which of the following?

Acute respiratory distress syndrome

The nurse is caring for a client who has recurrent sinusitis. Which consideration could the nurse suggest to best decrease the frequency of infections?

Administer an over-the-counter decongestant

A client comes into the emergency department with epistaxis. What intervention should the nurse perform when caring for a client with epistaxis?

Apply direct continuous pressure

The clinic nurse is caring for a client with acute bronchitis. The client asks what may have caused the infection. What may have caused the infection. What may induce acute bronchitis?

Chemical irritation

The nurse is reviewing the patient's blood gas results. The PaO2 is 96 mm Hg, the pH is 7.20, PaCO2 is 55 mm Hg, and HCO3 is 25 mEq/l. What might the nurse expect to observe on assessment of the patient?

Disorientation and tremors

A nurse is preparing to administer diphenhydramine to a client with bronchial irritation. Which activity should the nurse prioritize during the preadministration assessment?

Document color and amount of any sputum present

What is the reason for chest tubes after thoracic surgery?

Draining secretions, air, and blood from the thoacic cavity is necessary.

The client is caring for a client status postnasal polyectomy. What should the nurse instruct this client to report?

Excessive swallowing

Which of the following provides the best example of documentation for a client who is presenting with acute bronchitis?

Expectorating moderate amounts of thick, green mucus.

Which patient finding would the nurse identify as being a risk factor for altered transport of oxygen?

Hemoglobin level of 8.0

The nurse is assigned a group of patients. Which patient finding would the nurse identify as a factor leading to increased risk for impaired gas exchange?

Hemoglobin of 8.5 g/dL

A nurse is conducting an ongoing assessment and notes the client is experiencing difficulty brining up mucus. Which nursing diagnosis should the nurse prioritize for this client?

Ineffective airway clearance

The nursing instructor is discussing with senior nursing students about diagnostic procedures used in respiratory diseases. The instructor discusses thoracentisis defining it as a procedure performed for diagnostic purposes or to aspire accumulated excess fluid or air from the pleural space. What would the instructor tell the students purulent fluid indicates?

Infection

The nurse is in the radiology unit of the hospital. The nurse is caring for a client who is scheduled for a lung scan. The nurse knows that lung scans need the use of radiostopes and a scanning machine. Before the perfusion, what must the client be assessed for?

Iodine allergy

What happens to the diaphragm during inspiration?

It contracts and flattens

The nurse is assessing a client's potential for pulmonary emboli. What finding indicates possible deep vein thrombosis.

Localized calf tenderness

The nurse is completing a nutritional assessment on a patient with hypertension. What foods would be recommended for this patient?

Low sodium diet

The nurse is caring for client who has just been diagnosed with lung cancer. What is a cardinal sign of lung cancer?

Mucopurulent sputum

The nurse would identify which patient condition as a problem of impaired exchange secondary to a perfusion problem?

Peripheral arterial disease of the lower extremities

A client with a nonproductive cough is prescribed codeine sulfate. The nurse will question this order for clients with which history?

Premature infant

The client has just has an invasive procedure to assess the respiratory system. What does the nurse know should be assessed on this client?

Respiratory distress

An 18-month-old child is brought to the emergency department by his parents who explain that their child swallowed a watch battery. Radiologic studies show that the battery is in the lungs. Which area is the battery most likely to be in?

Right upper lung

The home care nurse is assessing an older patient diagnosed with mild cognitive impairment (MCI) in the home setting. Which information is of concern?

The patient has lost 10 pounds (4.5 kg) during the last month.

The nurse is performing a postoperative assessment on a client who is scheduled for a tonsillectomy. Why would the nurse ask the client about the use of herbal supplements?

They may prolong bleeding

The nurse is studying for a ohysiology test over the respiratory system. What should the nurse know about central chemoreceptors in the medulla?

They respond to changes in CO2 levels and hydrogen ion concentration (pH) in the cerebrospinal fluid.

During a nutritional assessment, the nurse calculates that a female patient's BMI is 27. The nurse would advise the patient to follow which of these recommendations?

This measurement indicates that the patient is overweight and should follow a plan of diet and exercise to lose weight.

A nurse is caring for a client who has frequent upper respiratory infections. Which structure is most helpful in protecting against infections?

Tonsils

What is the difference between respiration and ventilation?

Ventilation is the movement of air in and out of the respiratory tract