Med Surg Midterm NCLEX Style - Respiratory

The nurse is caring for a client who is prescribed a long-acting beta2 agonist. The client states, The medication is too expensive to use every day. I only use my inhaler when I have an attack. How should the nurse respond? A. You are using the inhaler incorrectly. This medication should be taken daily. B. If you decrease environmental stimuli, it will be okay for you to use the inhaler only for asthma attacks. C. Tell me more about your fears related to feelings of breathlessness. D. It is important to use this type of inhaler every day. Lets identify potential community services to help you.

D Rationale: Long-acting beta2 agonists should be used every day to prevent asthma attacks. This medication should not be taken when an attack starts. Asthma medications can be expensive. Telling the client that he or she is using the inhaler incorrectly does not address the clients financial situation, which is the main issue here. Clients with limited incomes should be provided with community resources. Asking the client about fears related to breathlessness does not address the clients immediate concerns.

A client admitted for pneumonia has been tachypneic for several days. When the nurse starts an IV to give fluids, the client questions this action, saying I have been drinking tons of water. How am I dehydrated? What response by the nurse is best? A. Breathing so quickly can be dehydrating. B. Everyone with pneumonia is dehydrated. C. This is really just to administer your antibiotics. D. Why do you think you are so dehydrated?

A Rationale: Tachypnea and mouth breathing, both seen in pneumonia, increase insensible water loss and can lead to a degree of dehydration. The other options do not give the client useful information.

A client has been diagnosed with TB. What action by the nurse takes highest priority? A. Educating the client on adherence to the treatment regimen B. Encouraging the client to eat a well-balanced diet C. Informing the client about follow-up sputum cultures D. Teaching the client ways to balance rest with activity

A Rationale: The treatment regimen for TB ranges from 6 to 12 months, making adherence problematic for many people. The nurse should stress the absolute importance of following the treatment plan for the entire duration of prescribed therapy. The other options are appropriate topics to educate this client on but do not take priority.

A 68-year-old client with COPD is being seen for pulmonary rehabilitation. The nurse is instructing the client on exercise guidelines for managing the disease. Which information must the nurse include as part of exercise guidelines for this client? A. The client will be monitored during exercise to address safety B. The client should wear a Holter monitor when exercising at home C. The client will need to receive nebulizer treatments prior to starting exercise D. The client should log exercise hours and bring in a copy to the rehab center

A. Rationale: "The client will be monitored during exercise to address safety" is correct. Part of pulmonary rehabilitation is to educate the client about guidelines for activity levels. While it is important for a client with COPD to get enough exercise, the nurse also needs to address the client's safety to prevent harm from exercise that is too intense. When starting pulmonary rehab, the client will most likely need to be monitored while exercising.

The nurse is caring for a client just admitted with a dx of pulmonary cystic fibrosis. what should be the priority goal when planning care for this client? A. improving airway clearance B. Removing allergens from the environment C. Eliminating foods the client does not absorb D. Preparing client for the CF-specific sweat test

A. Rationale: Ineffective airway clearance is the major challenge for persons with cystic fibrosis. Irritants in the environment can trigger exacerbation in these clients, but is not the priority in this situation.

The nurse is teaching a client w/ newly diagnosed emphysema how to managed the disease. The client asks how pursed-lip breathing helps manage symptoms. What would be the nurse's best response? A. "It prevents air spaces in the lungs from trapping air" B. "It decreases the pressure in the airways." C. "The resistance on exhalation increases muscle strength in the diaphragm." D. "It helps slow the respiratory rate."

A. Rationale: Pursed lip breathing is a technique in which clients exhale through pursed lips to delay air trapping during airway compression. It actually increases airway pressure.

A school is offering tuberculosis testing for all of its employees. The health nurse administers the injections to each of the employees using a tuberculin syringe. At which angle does the nurse administer the injections into the skin? A. 10 degree B. 90 degree C. 25 degree D. 60 degree

A. Rationale: "10 degree" is correct. When a nurse administers an intradermal injection to test for tuberculosis, she should insert the needle at a 5 to 15-degree angle (or nearly flat against the skin). Inserting the needle at this angle will allow the nurse to inject the solution just under the skin to create a wheal for testing.

A 28-year-old woman arrives at the hospital in active labor. The client stayed at home as long as possible because she also has pneumonia. In addition to caring for the client during her delivery, which of the following interventions would the nurse also need to apply in this situation? A. Administer supplemental oxygen to the mother so that the fetus will have enough oxygen B. Administer pain medication to help the mother push and deliver the baby more quickly C. Administer cough medicine to help the client get through the delivery with less frequent coughing D. Administer extra fluids, including oxytocin to cause labor to progress rapidly

A. Rationale: "Administer supplemental oxygen to the mother so that the fetus will have enough oxygen" is correct. Pneumonia occurs as an infection in the lung tissue. It may lead to atelectasis and collapse of the alveoli, which can impair gas exchange. In this situation, the mother will need extra oxygen not only for herself, but also for the baby before it is born. The nurse should administer supplemental oxygen throughout the time that the mother is in labor to promote adequate oxygenation for the fetus and to prevent fetal hypoxia.

A client with COPD is receiving care at the primary provider's clinic with worsening of symptoms of emphysema. The provider orders an outpatient chest x-ray to determine if there have been any changes in lung structure. Which best describes what would show on a chest x-ray in the later stages of emphysema? A. Flattened diaphragm B. A mediastinal shift to the right C. Plaque formation scattered throughout the lung D. Increased size of the heart

A. Rationale: "Flattened diaphragm" is correct. Emphysema is a form of COPD that occurs when the walls of the lung alveoli are destroyed. The lungs are no longer flexible in their ability to expand and contract normally, so the lungs become large and hyperinflated. Their increased size presses on the diaphragm at the base of the lung field so that it appears low and flattened on a chest x-ray.

A nurse is caring for a client who has tuberculosis. The client is just completing a 9-month regimen of medication as part of treatment for the condition in which she responded well. Which of the following choices describes how follow-up is handled for the client who was treated successfully? A. Follow-up is needed only if the client experiences symptoms of TB B. The client needs an annual follow-up chest x-ray C. The client needs a follow-up chest x-ray and sputum culture one time D. The client needs a follow-up chest x-ray and sputum culture one time

A. Rationale: "Follow-up is needed only if the client experiences symptoms of TB" is correct. The standard form of treatment for tuberculosis is a 6 to 12 month regimen of medication, which is usually effective for most clients. After completing a therapeutic regimen, the client does not necessarily need routine follow-up unless he develops further symptoms of TB.

A client is being admitted to the hospital from home with complications of tuberculosis. When making a room assignment, the nurse would most likely consider which of the following factors? A. The hospital's isolation procedures B. Whether the client will have someone staying with him C. The nurses assigned to work during the shift D. Whether a nursing assistant is available to help the client

A. Rationale: "The hospital's isolation procedures" is correct. Most client room assignments are made based on the client's condition and the availability of staff. In this situation, the client has an infectious condition and needs a specific room that has a negative pressure air system. Therefore in this case, the client's assignment is based on the hospital's isolation procedures for a client with an airborne illness.

A nurse who works in a long-term care facility has learned that one of the residents has developed active tuberculosis. What should the nurse do to protect the other residents? A. Allow the client to remain in the nursing home but provide isolation precautions and treat the active disease B. Administer masks to all residents and ask them to wear them around the infected client C. Isolate the client from everyone else except the client's roommate, who most likely has already been exposed D. Do not allow visitors to the center until the client has been adequately treated

A. Rationale: A client with active tuberculosis has the potential to transmit the infection to others and is considered contagious. In a long-term care facility, the client should receive treatment for the disease and should be isolated from other residents until the potential for the spread of the infection is past, which is one to two weeks after treatment is started. Other residents should be tested for exposure to tuberculosis using the Mantoux skin test.

A nurse must use a N95 respirator for protection against tuberculosis with a client. Which of the following considerations should be used while the nurse is utilizing this mask? A. The mask must be fitted specifically for the nurse B. The N95 respirator will not protect against influenza C. When a N95 respirator is not available, the nurse should use a surgical mask instead D. The N95 respirator does not provide a seal around the sides of the mask

A. Rationale: An N95 respirator is a special type of mask worn by the nurse to filter out airborne particles of microorganisms. The respirator is designed to protect the wearer against pathogens of a specific size, such as tuberculosis. It must be fitted specifically for the nurse to ensure there is a tight seal against the face. The N95 respirator is not the same as a surgical mask and the two are not interchangeable.

While assessing a client who has facial trauma, the nurse auscultates stridor. The client is anxious and restless. Which action should the nurse take first? A. Contact the provider and prepare for intubation. B. Administer prescribed albuterol nebulizer therapy. C. Place the client in high-Fowlers position. D. Ask the client to perform deep-breathing exercises.

A. Rationale: Facial and neck tissue edema can occur in clients with facial trauma. Airway patency is the highest priority. Clients who experience stridor and hypoxia, manifested by anxiety and restlessness, should be immediately intubated to ensure airway patency. Albuterol decreases bronchi and bronchiole inflammation, not facial and neck edema. Although putting the client in high-Fowlers position and asking the client to perform breathing exercises may temporarily improve the clients comfort, these actions will not decrease the underlying problem or improve airway patency.

An RN is working as a school nurse in a local high school. The nurse has a health aide who also works in the health office. One of the students comes into the office for his daily dose of Singulair for control of asthma. Which best describes the nurse's consideration of delegating the administration of this drug to the health aide? A.The nurse can delegate the action if the health aide has completed a documented training course for medication administration B.The health aide cannot administer the drug to the student because she is not a registered nurse C. The health aide can only administer drugs for ADHD or for pain in the high school setting D. The nurse can delegate the action only if she is observing the health aide give the drug

A. Rationale: Many schools across the country employ health aides to work in the school health office. An RN may or may not be present in the health office at all times, but she can delegate the administration of some medications to students who have prescriptions to take while in school, as the state allows. The RN is responsible for the outcome of the delegation, but she can delegate the administration of some medications if the health aide has taken a training course and the RN has documented the aide's training.

A client appears dyspneic, but the oxygen saturation is 97%. What action by the nurse is best? A. Assess for other manifestations of hypoxia. B. Change the sensor on the pulse oximeter. C. Obtain a new oximeter from central supply. D. Tell the client to take slow, deep breaths.

A. Rationale: Pulse oximetry is not always the most accurate assessment tool for hypoxia as many factors can interfere, producing normal or near-normal readings in the setting of hypoxia. The nurse should conduct a more thorough assessment. The other actions are not appropriate for a hypoxic client.

A nurse is working in the ED and has just received a client with an asthma exacerbation. Which of the following positions would be the most conducive to effective gas exchange for this client? A.Dorsal Recumbant B.High-Fowler's C.Prone D.Trendelenburg

B. Rationale: High-Fowler's is the client sitting straight upright, which would best facilitate breathing and gas exchange in a client with an asthma exacerbation.

The nurse is caring for a client whose chest x-ray shows pneumonia. The provider has placed the following orders: vancomycin IV, piperacillin/tazobactam IV, blood and sputum cultures, vitals now and every 4 hours. Which order needs to be completed first? A. Vitals B. Vancomycin C. Blood and sputum cultures D. Piperacillin/tazobactam

A. Rationale: The order reads "vitals now", which means vital signs should be taken first. After vital signs, the nurse would draw blood cultures, then the antibiotics would be administered. It is essential to draw cultures prior to antibiotic initiation, because the antibiotics will impact culture results.

The nurse is caring for a client who has pneumonia. Which of the following are warning signs that the client may be going septic? Select all that apply. A. Tachypnea B. Decreased urination C. Bradycardia D. Hypotension E. Chills

A. , B. , D. , E. Rationale: Chills indicate fever, which is a sign of infection. This can indicate sepsis.A respiratory rate above 20 per minute is a sign of sepsis. Hypotension is a sign of sepsis. A septic client will demonstrate decreased urination due to hypoperfusion of the kidneys. Tachycardia is a sign of sepsis, but not bradycardia.

The nurse knows that which of the following are risk factors for hospital-acquired pneumonia? Select all that apply. A. Advanced age B. Aspiration C. Not getting the influenza vaccine D. Not getting the pneumococcal vaccine E. Mechanical ventilation

A. , B. , E. Rationale: A person of advanced age is more likely to get hospital-acquired pneumonia.Aspiration in the hospital can lead to HAP. Hospital-acquired pneumonia (HAP) risk factors include advanced age, chronic lung diseases, aspiration, mechanical ventilation, decreased level of consciousness, and a suppressed immune system.

A client with a lung infection must undergo an ABG. The client asks the nurse why this lab test is necessary. Which of the following should the nurse include that would explain the reasons for this test? Select all that apply. A. The test will assess for the acid and base balances in the bloodstream B. The test will diagnose the type of lung infection the client has C. The test checks to see how well the lung treatments are working D. The test verifies the need for a blood transfusion E. The test will determine if the client needs extra oxygen

A. , C. , E Rationale: "The test checks to see how well the lung treatments are working", "The test will determine if the client needs extra oxygen", and "The test will assess for the acid and base balances in the bloodstream" are correct. An arterial blood gas is a standard test administered to assess carbon dioxide and oxygen levels of the blood. The test does not diagnose a lung condition, but it can determine if the client is getting enough oxygen, which also determines whether the lung treatments the client receives are effective. Additionally, the test will determine if there is an acid-base imbalance present.

The nurse knows that which of the following are risk factors for chronic obstructive pulmonary disease (COPD)? Select all that apply. A. Smoking B. Humidifier exposure C. Asbestos D. Working in a hospital E. Smoke exposure

A. , C. , E., Rationale: COPD is present when a client has chronic bronchitis and emphysema leading to obstruction of airflow. Risks include smoking, smoke exposure, air pollution, asbestos, and alpha-1 antitrypsin deficiency.

A nurse is caring for a patient who has developed ventilator-associated pneumonia while in the hospital. Which of the following strategies could the nursing unit apply that would best prevent hospital-acquired infections? Select all that apply. A. Use standard precautions at all times when providing patient care B. Utilize invasive devices to gather important data, such as vital signs C. Promote appropriate hand hygiene D. Wear the same pair of gloves during multiple patient contact E. Wash hands with soap and water when visibly soiled

A. , C., E. Rationale: "Promote appropriate hand hygiene", "Use standard precautions at all times when providing patient care" and "Wash hands with soap and water when visibly soiled" are correct. A hospital-acquired infection (HAI) occurs in a health care facility and can cause serious complications for patients that are already sick. Many patients' immune systems are already lowered due to illness or medications, and in the hospital they are exposed to pathogens to which they have not developed resistance. Some common HAI's are ventilator-associated pneumonia, Clostridium difficile, urinary tract infections and central line associated infections.

Which of the following are considered anti-tubercular drugs? Select all that apply. A. Isoniazid B. Sulfamethoxazole and trimethoprim C. Ceclor D. Ethambutol E. Rifampin

A. , D. , E. , Rationale: Isoniazid is a first-line medication used to treat tuberculosis. First-line agents provide the most effective antituberculosis treatment. If treatment with first-line agents fail, second-line drugs are added, but are more toxic to the client. Tuberculosis is difficult to treat because there is a waxy substance on the bacterium capsule that is difficult to penetrate and destroy. Rifampin is a first-line medication used to treat tuberculosis. Ethambutol is a first-line medication used to treat tuberculosis.

A patient with asthma has started a new prescription for albuterol (Proventil HFA). What side effects are associated with use of this drug? Select all that apply. A. Restlessness B. Pounding heart rate C. Tremor in the extremities D. Depression E. Vomiting

A., B, C Rationale: Shakiness, and restlessness are also the side effects of Albuterol.It may also have negative side effect that causes a pounding heart rate. Albuterol is a drug used to open the airways and facilitate easier breathing. It may also have negative side effects that causes tremor in the extremities.

A nurse administers medications to a client who has asthma. Which medication classification is paired correctly with its physiologic response to the medication? A. Bronchodilator stabilizes the membranes of mast cells and prevents the release of inflammatory mediators B. Cholinergic antagonist causes bronchodilation by inhibiting the parasympathetic nervous system C. Corticosteroid relaxes bronchiolar smooth muscles by binding to and activating pulmonary beta2 receptors D. Cromone disrupts the production of pathways of inflammatory mediators

B Rationale: Cholinergic antagonist drugs cause bronchodilation by inhibiting the parasympathetic nervous system. This allows the sympathetic nervous system to dominate and release norepinephrine that actives beta2 receptors. Bronchodilators relax bronchiolar smooth muscles by binding to and activating pulmonary beta2 receptors. Corticosteroids disrupt the production of pathways of inflammatory mediators. Cromones stabilize the membranes of mast cells and prevent the release of inflammatory mediators.

An older adult is brought to the emergency department by a family member, who reports a moderate change in mental status and mild cough. The client is afebrile. The health care provider orders a chest x-ray. The family member questions why this is needed since the manifestations seem so vague. What response by the nurse is best? A. Chest x-rays are always ordered when we suspect pneumonia. B. Older people often have vague symptoms, so an x-ray is essential. C. The x-ray can be done and read before laboratory work is reported. D. We are testing for any possible source of infection in the client.

B Rationale: It is essential to obtain an early chest x-ray in older adults suspected of having pneumonia because symptoms are often vague. Waiting until definitive manifestations are present to obtain the x-ray leads to a costly delay in treatment. Stating that chest x-rays are always ordered does not give the family definitive information. The x-ray can be done while laboratory values are still pending, but this also does not provide specific information about the importance of a chest x-ray in this client. The client has manifestations of pneumonia, so the staff is not testing for any possible source of infection but rather is testing for a suspected disorder.

A pulmonary nurse cares for clients who have chronic obstructive pulmonary disease (COPD). Which client should the nurse assess first? A. A 46-year-old with a 30pack-year history of smoking B. A 52-year-old in a tripod position using accessory muscles to breathe C. A 68-year-old who has dependent edema and clubbed fingers D. A 74-year-old with a chronic cough and thick, tenacious secretions

B Rationale: The client who is in a tripod position and using accessory muscles is working to breathe. This client must be assessed first to establish how well the client is breathing and provide interventions to minimize respiratory failure. The other clients are not in acute distress.

A postop client with emphysema is receiving O2 at 2L/min via NC when the client reports SOB. The spouse asks the RN to increase the O2 to help the client's breathing. Which response by the RN is appropriate? A. "I will switch him to 100% nonrebreather mask." B. "Higher concentration of O2 may decrease breathing and cause more difficulty." C. "I think you should leave for an hour; it's just anxiety and rest will improve the breathing." D. "This is an indication that he is in pain; I will treat that."

B. Rationale: CO2 level is one of the primary stimuli for breathing for COPD clients, who adjust to higher than normal CO2 levels. Abrupt elevation of the O2 level will depress the stimulus for breathing and can produce respiratory arrest.

A 20-year-old patient with asthma is being seen for acute exacerbation of symptoms. The nurse talks with the patient about their lifestyle and what medications they take at home. Which medication would warrant the nurse providing further teaching about the patient's condition? A. Acetaminophen B. Aspirin C. Bacitracin D. Docusate sodium

B. Rationale: "Aspirin" is correct. Up to 20 percent of patients with asthma have negative effects after taking aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs). These can cause a sudden and severe asthma attack, referred to as AIA, or aspirin-induced asthma. In the patient with AIA, bronchoconstriction, nasal polyps and rhinoconjunctivitis follows the ingestion of aspirin. The nurse should counsel the client to avoid taking aspirin and to use a different kind of pain reliever instead.

A nurse is caring for an older adult client who has a pulmonary infection. Which action should the nurse take first? A. Encourage the client to increase fluid intake. B. Assess the pt's level of consciousness. C. Raise the head of the bed to at least 45 degrees. D. Provide the client with humidified oxygen.

B. Rationale: Assessing the pt's level of consciousness will be most important because it will show how the client is responding to the presence of the infection. Although it will be important for the nurse to encourage the client to turn, cough, and frequently breathe deeply; raise the head of the bed; increase oral fluid intake; and humidify the oxygen administered, none of these actions will be as important as assessing the level of consciousness. Also, the client who has a pulmonary infection may not be able to cough effectively if an area of abscess is present.

A client has been taking isoniazid (INH) for tuberculosis for 3 weeks. What laboratory results need to be reported to the health care provider immediately? A. Albumin: 5.1 g/dL B. Alanine aminotransferase (ALT): 180 U/L C. Red blood cell (RBC) count: 5.2/mm3 D. White blood cell (WBC) count: 12,500/mm3

B. Rationale: INH can cause liver damage, especially if the client drinks alcohol. The ALT (one of the liver enzymes) is extremely high and needs to be reported immediately. The albumin and RBCs are normal. The WBCs are slightly high, but that would be an expected finding in a client with an infection.

The nurse is admitting a client with pneumonia. The client's ABCs are intact. Which is the priority for this client? A. Give IV steroids B. Give IV antibiotics C. Give IV insulin D. Give IV fluids

B. Rationale: The nurse will need to obtain baseline labs as ordered by the provider. Once this is done, the first thing on the list is to initiate IV antibiotic therapy to treat the infection. Remember, while IV fluids are important, the priority is to begin antibiotics. IV steroids are usually given for clients with COPD exacerbation, and inflammatory diseases such as lupus, RA, and asthma. IV steroids are not routinely given for pneumonia.

A nurse is caring for a patient diagnosed with asthma. The nurse administers the patient's most recent dose of theophylline. Which of the following must the nurse consider when administering this medication? A. The patient should take it before going to bed B. The patient should avoid caffeine with this medication C. The patient should limit intake of fluids with this medication D. The patient should be given adjuvant medications to treat nasal and respiratory symptoms in addition to the theophylline

B. Rationale: Theophylline is a medication used to treat symptoms of shortness of breath and wheezing from asthma, emphysema and bronchitis. It works by relaxing the bronchioles, which makes it easier to breathe. It may also cause jitteriness and shakiness and a rapid pulse rate in the patient. The patient should avoid caffeine, which could worsen symptoms

While caring for a client who is recovering from surgery, the nurse finds out that the client is infected with active tuberculosis. Prior to this discovery, the nurse had only been using standard precautions. Which action of the nurse is most appropriate for providing proper precautions in this situation? A. Start using precautions right away by wearing a gown and gloves while providing client care B. Start using precautions right away by placing the client in a negative pressure room and using a respirator mask C. Notify the provider and tell the next shift that they will have to start using precautions D. Notify the provider and tell the next shift that they will have to start using precautions

B. Rationale; Isolation precautions are used for different types of infectious conditions to prevent the transmission of illness. A client with active TB requires airborne precautions, which include isolation in a negative-pressure room and the use of a specialized filter mask when providing care. Airborne precautions should be implemented right away, even if this nurse was unaware of the condition before.

A patient with COPD has developed malnutrition and weight loss since his diagnosis 8 years ago. Which describes the most likely reason why a COPD patient is at higher risk of malnutrition? A. An inability to absorb fat-soluble vitamins in the digestive tract B. Increased energy expenditure used to maintain adequate breathing C. Frequent aspiration of stomach contents that causes breathing difficulties D. Increased instances of gastroesophageal reflux

B. Rationale: "Increased energy expenditure used to maintain adequate breathing" is correct. A patient with advanced COPD is at risk of malnutrition and weight loss because of the high-energy expenditure he requires for breathing. A COPD patient may spend a large amount of his time working to breathe, which uses up many calories. Intake is also reduced if the patient has such difficulties with breathing that it is too challenging to try to eat and breathe at the same time. Consequently, many patients with COPD lose weight over time and become malnourished or cachexic.

The RN considers that which concept should have a priority for discussion during discharge teaching for a client who has chronic bronchitis? A. Fluid restriction B. Smoking cessation C. Avoidance of crowds D. Side effects of drug therapy

B. Rationale: Cigarette smoking is the primary etiology of chronic bronchitis, so cessation is the priority for the client. Avoidance of crowds to lower the risk of pulmonary infection is a recommendation that is individualized and less common than the need for smoking cessation.

The RN is caring for a client diagnosed with right middle lobe pneumonia. The nurse should prefor which interventions to mobilize secretions? Select all that apply. A. Administer abc as prescribed B. Encourage client to increase intake of oral fluids C. Place the client in a prone position to increase alveolar expansion D. Explain that client should alternate activity periods w/ rest E. Assist client to use incentive spirometer hourly

B. + E. Rationale: Fluids and humidification liquefy secretions, making them easier to mobilize; the clients should increase oral fluids. Helping clients deep breathe or use the incentive spirometer promotes maximum lung expansion, mobilizes secretions, and encourages cough.

A client has been brought to the emergency department after developing pneumonia. The client's arterial blood gas results show respiratory alkalosis. Which of the following signs or symptoms would the nurse expect to see with this condition? Select all that apply. A. Deep purple rash on the trunk B. Confusion C. Epigastric pain D. Hyperventilation E. Numbness and tingling in extremities

B. , C. , D. , E. Rationale: "Hyperventilation", "Numbness and tingling in extremities", "Confusion", and "Epigastric pain" are correct. Respiratory alkalosis occurs as an alteration in normal blood gas patterns, typically as a result of conditions that overstimulate the respiratory system. This results in a decrease in hydrogen ion concentration because of a decrease in PaCO2. The classic sign is hyperventilation, often at a rate of over 40/minute. The client may experience tetany, numbness and tingling of the extremities as well as hyperreflexia and seizures. They may have nausea, emesis and cardiac dysrhythmias as well.

A nurse is demonstrating how to use a metered-dose inhaler to a patient with asthma. Which of the following elements should the nurse include as part of this teaching? Select all that apply. A. The patient should immediately breath out after inhaling the medication B. The patient should avoid putting the mouthpiece in the mouth without a spacer, if possible C. The patient should not use the inhaler again for at least 5 minutes after the first dose D. The patient should shake the inhaler well before using E. The patient should press the canister while taking a deep breath

B. , D. , E. Rationale: "The patient should shake the inhaler well before using", "The patient should avoid putting the mouthpiece in the mouth without a spacer, if possible" and "The patient should press the canister while taking a deep breath" are correct. When using a metered-dose inhaler, the patient must coordinate expelling the medication and breathing it in. The patient should not put the mouthpiece in his mouth without using a spacer, unless the spacer is unavailable, therefore the patient should try to avoid this if a spacer is available. After inhaling the medication, the patient should hold his breath for 10-15 seconds to allow the medication to disperse through the respiratory tract

The nurse is caring for a client in the short procedure unit following a bronchoscopy using me rate sedation. Prior to discharging the client, the nurse should verify that the client, the nurse should verify that the client has achieved which priority outcome? A. Verbalized symptoms of late complications B. Demonstrates an intact gag reflex C. Remains afebrile for up to 2 postoperative days D. Reports being thirsty and asks for oral fluids

B. Demonstrates an intact gag reflex Rationale: An intact gag reflex indicates that topical sedation has lost its effect and the client is able to swallow.

A nurse cares for a client with chronic obstructive pulmonary disease (COPD) who appears thin and disheveled. Which question should the nurse ask first? A. Do you have a strong support system? B. What do you understand about your disease? C. Do you experience shortness of breath with basic activities? D. What medications are you prescribed to take each day?

C Rationale: Clients with severe COPD may not be able to perform daily activities, including bathing and eating, because of excessive shortness of breath. The nurse should ask the client if shortness of breath is interfering with basic activities. Although the nurse should know about the clients support systems, current knowledge, and medications, these questions do not address the clients appearance.

A nurse has educated a client on isoniazid (INH). What statement by the client indicates teaching has been effective? A. I need to take extra vitamin C while on INH. B. I should take this medicine with milk or juice. C. I will take this medication on an empty stomach. D. My contact lenses will be permanently stained.

C Rationale: INH needs to be taken on an empty stomach, either 1 hour before or 2 hours after meals. Extra vitamin B needs to be taken while on the drug. Staining of contact lenses commonly occurs while taking rifampin (Rifadin).

A nurse cares for a client with chronic obstructive pulmonary disease (COPD). The client states that he no longer enjoys going out with his friends. How should the nurse respond? A. There are a variety of support groups for people who have COPD. B. I will ask your provider to prescribe you with an antianxiety agent. C. Share any thoughts and feelings that cause you to limit social activities. D. Friends can be a good support system for clients with chronic disorders.

C Rationale: Many clients with moderate to severe COPD become socially isolated because they are embarrassed by frequent coughing and mucus production. They also can experience fatigue, which limits their activities. The nurse needs to encourage the client to verbalize thoughts and feelings so that appropriate interventions can be selected. Joining a support group would not decrease feelings of social isolation if the client does not verbalize feelings. Antianxiety agents will not help the client with social isolation. Encouraging a client to participate in activities without verbalizing concerns also would not be an effective strategy for decreasing social isolation.

A nurse checks a client's oxygen saturation by using a bedside sensory probe. The client has pneumonia that is currently being treated with antibiotics. When the nurse places the pulse oximeter probe on the client, the first reading she notes is 89 percent. Which of the following actions should the nurse perform first? A. Administer 100 percent oxygen and monitor the pulse oximetry until it reaches 95 percent B. Raise the head of the bed and ask the client to take a deep breath C. Assess the probe site to ensure an accurate reading D. Contact the provider for a chest x-ray

C. Rationale: "Assess the probe site to ensure an accurate reading" is correct. A bedside pulse oximeter can measure a client's oxygen levels using a bedside machine with a probe. Although the probe is usually accurate, it may reflect abnormal readings due to excessive client movement or if the probe is in an incorrect position. If the machine alarms, the first action of the nurse is to check the probe site and make sure it is still in the proper position. However, a pulse oximetry reading of 89% in a client with pneumonia would not be abnormal.

After teaching a client who is prescribed a long-acting beta2 agonist medication, a nurse assesses the clients understanding. Which statement indicates the client comprehends the teaching? A. I will carry this medication with me at all times in case I need it. B. I will take this medication when I start to experience an asthma attack. C. I will take this medication every morning to help prevent an acute attack. D. I will be weaned off this medication when I no longer need it.

C. Rationale: Long-acting beta2 agonist medications will help prevent an acute asthma attack because they are long acting. The client will take this medication every day for best effect. The client does not have to always keep this medication with him or her because it is not used as a rescue medication. This is not the medication the client will use during an acute asthma attack because it does not have an immediate onset of action. The client will not be weaned off this medication because this is likely to be one of his or her daily medications

After teaching a client who is prescribed salmeterol, the nurse assesses the clients understanding. Which statement by the client indicates a need for additional teaching? A. I will be certain to shake the inhaler well before I use it. B. It may take a while before I notice a change in my asthma. C. I will use the drug when I have an asthma attack. D. I will be careful not to let the drug escape out of my nose and mouth.

C. Rationale: Salmeterol is designed to prevent an asthma attack; it does not relieve or reverse symptoms. Salmeterol has a slow onset of action; therefore, it should not be used as a rescue drug. The drug must be shaken well because it has a tendency to separate easily. Poor technique on the clients part allows the drug to escape through the nose and mouth.

The nurse is caring for a client with a recent tracheostomy they. The nurse should keep which principle of care in mind when working with this client? A. Client must be suctioned as needed using clean technique B. Tracheotomy tube must be capped to allow client to eat by mouth C. The oxygen or air needs to be humidified D. Saline can be inserted into the tracheotomy tube before suctioning if secretions are thick

C. Rationale: Because tracheostomy bypasses the normal airway's humidification, supplemental humidification is needed to keep the airways moist and prevent mucous plugs and airway occlusion from occurring. The tracheostomy is capped and the balloon is deflated to enable clients to speak.

A client presents to the ER complaining of shortness of breath. The client is able to get 2-3 words at a time between breaths. They are in the tripod position and keep saying, "Help me." What is the priority nursing intervention for this patient? A.Take a blood pressure B.Auscultate lung sounds C.Apply a non-rebreather D.Check capillary refill

C. Rationale: In this case, applying oxygen is urgent because it is apparent that the client is struggling from the information you already have. It may be prudent to obtain an oxygen saturation for a baseline if this can be done without delay. However, there is enough information in the stem to demonstrate a clear breathing problem, so you can move on from 'assessment'. In a real life clinical setting, getting an O2 sat, auscultating lung sounds, and applying O2 will all happen by multiple nurses within 1-2 minutes. **Test-taking tip: Think of priority questions this way - if I could literally ONLY do one of these things for the client....what would happen if I DON'T ____.

A nurse is working in the emergency room and receives report on 4 clients. The nurse knows to see the client with which of the following first? A. A client who is due for a breathing treatment B. A pulse ox that dips to 84% during ambulation C. COPD; a pulse ox of 88% on 4L NC, now restless D. Pulse oximeter of 90% on 2L NC and maintaining an O2 of 98% for the past 3 days

C. Rationale: "COPD; a pulse ox of 88% on 4L NC, now restless" is correct. This client has increasing O2 needs. Increasing restlessness is a sign of hypoxia. This client may need to be placed on BiPAP to help open the alveoli so CO2 and O2 can exchange. Remember, the client with a pulse ox that dips when walking can stay in bed until the nurse is able to address the issue. The priority is to see the client that is showing signs of hypoxia. A client on 4 L at 88% that is restless is showing signs of hypoxia.

A 60-year-old client is going through pulmonary rehabilitation for COPD. The nurse understands that an expected outcome of pulmonary rehabilitation is which of the following? A. The client experiences improvement in the damage from his lung disease B. The client no longer needs oxygen therapy C. The client has an easier time performing activities of daily living D. The client's pain from surgery has resolved

C. Rationale: "The client has an easier time performing activities of daily living" is correct. Pulmonary rehabilitation is designed to help a client with lung disease to improve their ability to perform activities of daily living and overall quality of life. The program may provide education about oxygen therapy and medications, offer tips for the client to exercise more, and often provides social support.

The nurse receives report on an adult client with pneumonia. During report the nurse notes that the client has a new-onset heart block on the EKG (prior EKGs showed normal sinus rhythm) and has been running a temperature. Which vital sign is the most important to monitor for this client? A. Blood pressure B. Respirations C. Heart rate D. Temperature

C. Rationale: A client who has a new-onset heart block must be monitored closely for bradycardia. They may require external pacing if they do not have a pacemaker, so monitoring this client's heart rate is the priority.

The nurse is reviewing instructions with a client who is being discharged home with oxygen for the first time. Which statement by the client demonstrates understanding of the instructions? A. "I should keep foods such as bread in the cupboards" B. "It's okay to have other people smoke, I just can't smoke while wearing my oxygen" C. "I won't store my oxygen in a closet" D. "I should avoid using lotion"

C. Rationale: Oxygen should not be stored in an area where air can become trapped, because the oxygen, which is a fuel source for fire, can build up to high concentrations and become a risk for fire or explosion.

The home health nurse is assessing an adolescent who has frequent school absences because of acute asthma attacks. Assessment reveals mild inspiratory wheezes and current SPO2 98%. The client can answer questions in full sentences and accurately demonstrates the use of inhalers. After documenting this data, what would be the next best action by the nurse? A. Report to home health agency that client has adequate knowledge of how to manage disease B. Inquire whether family members know CPR in event of a respiratory emergency C. Perform an environmental assessment to ID potential asthma triggers D. Consult w/ Department of Youth Services about truancy and possible neglect

C. Asthma is an inflammatory process of the airways that is triggered in response to allergens or non allergic irritants Frequently the triggers are in the environment, particularly down pillows, dust mites or pets.

A client with a dx of HIV has returned to the clinic 72 hrs after a tuberculin skin test was given with induration of mm at the administration site. The client is upset and states, "I can't believe I have TB!" Which statement by the nurse is most appropriate? A. "This could actually be a good result. It's less than 10mm." B. "The doctor will prescribe isoniazid for you to take for the next 3 months." C. "This finding does not confirm TB; it may indicate a recent exposure to TB." D. "We'll need to do a chest x-ray. This may be false positive because of your history of HIV."

C. Rationale: In HIV positive clients, an induration of 5-10mm after a tuberculin skin test indicates exposure to an individual infected with mycobacterium tuberculosis. He of HIV is not related to a false-positive tuberculin skin test, but is related to a positive result at measurements of greater than 5mm.

The nurse is caring for a client who has a sudden asthma attack. Which inhaler does the nurse know to give first? A.Cromolyn B.Flucotasone C.Albuterol D.Azmacort

C. Rationale: This is a beta-2 agonist, which is an acute bronchodilator and should be given first.

When reinforcing healthcare provider information to a client scheduled for a bedside thorcentnesis, what should the nurse explain as the primary purpose for this procedure? A. Obtaining pleural tissue for evaluation B. Determining the stage of a lung tumor C. Withdrawing fluid from the pleural space D. Examining the pleural space directly for abnormalities

C. Rationale: Thoracentesis is used to withdraw files or air from the pleural space for diagnostic and therapeutic purposes.

The nurse is caring for a client in status asthmaticus. Which of the following is a priority nursing action? A.Monitor the client's respiratory status for signs of hypoxia B.Administer aminophylline IV per provider order C.Give inhaled bronchodilator therapy as ordered D.Provide emotional support

C. Rationale: While all the options are appropriate actions for a client in status asthmaticus, inhaled bronchodilators work the fastest and should always be given first in this client scenario.

A provider orders a CBC for a male client who has been admitted to the hospital for pneumonia. Which of the following results would be considered abnormal on the CBC? Select all that apply. A. Hematocrit 50% B. Platelets 200,000 cells/mcL C. Hemoglobin 10.2 g/dL D. WBC 8,000/mcL E. RBC 3.8/mcL

C. , E. Rationale: "RBC 3.8/mcL" and "Hemoglobin 10.2 g/dL" are correct. A complete blood count (CBC) is a measure of the blood cells in the client's blood sample. Some elements of the CBC measure red blood cells, white blood cells, hemoglobin, and hematocrit levels, among others. The results of the CBC can indicate a number of conditions that occur in the bloodstream, particularly when illness is present. A normal RBC value is between 4.5 - 5.5 mcL for males, and a normal Hbg value is between 13.5 - 16.5 g/dL.

The nurse is caring for a 68 yo client who is scheduled for discharge later that day. An ABG done the previous morning reveals a PaO2 of 87 mmHg. The client has a RR of 22 clear lungs and reports no shortness of breath. What should the nurse's response? A. Call the HCP to report the PaO2 B. Monitor the client more closely because a physiological abnormality is beginning C. Do nothing because a PaO2 of 87 is normal in an older adult D. Call the family to tell them to anticipate that the discharge will be canceled

C. The PaO2 normally drops as the individual ages and can be as low as 83 in a 90 yo. The client's assessment is normal.

The nurse is caring for a client diagnosed with pneumothorax, which is being treated with a chest tube to re-expand the lung. Which actions are appropriate for the nurse to tak when caring for this client? Select all that apply. A. Clamp chest tube when assisting client from bed to chair. B. Report fluctuations in water seal section of chest drainage system C. Maintain an occlusive dressing, such as a petrolatum gauze, around the chest tube at insertion site. D. Gently massage chest tubes hourly to promote chest drainage. E. Encourage client to maintain a high Fowler's position.

C., E. Rationale: Chest tubes are inserted into the pleural space to drain fluids or air from the pleural space and promote lung reexpansion. If the drainage system is occluded in any way, reexpansion can be prevented or fluid and air can accumulate and cause a tension pneumothorax. Fluctuations in the water seal are normal and represent normal inspiration and expiration.

A nurse is reviewing the principles of COPD management with a client. Which of the following suggestions would most likely support the health of the client with COPD? A. Exercise for 30 minutes per day, 6 days a week B. Reduce the amount of cigarettes smoked each day C. Avoid drinks that contain caffeine just before bed D. Avoid extremes in temperatures

D. Rationale: A client with COPD suffers from a chronic disease that can progressively worsen, especially with poor health management. As part of health education, the nurse must teach the client important facts that will most support overall health. This includes smoking cessation, avoiding extremes in temperatures, limiting activity and alternating activity with rest periods, meeting nutritional requirements, and recognizing the signs of respiratory distress.

A nurse assesses several clients who have a history of asthma. Which client should the nurse assess first? A. A 66-year-old client with a barrel chest and clubbed fingernails B. A 48-year-old client with an oxygen saturation level of 92% at rest C. A 35-year-old client who has a longer expiratory phase than inspiratory phase D. A 27-year-old client with a heart rate of 120 beats/min

D. Rationale: Tachycardia can indicate hypoxemia as the body tries to circulate the oxygen that is available. A barrel chest is not an emergency finding. Likewise, a pulse oximetry level of 92% is not considered an acute finding. The expiratory phase is expected to be longer than the inspiratory phase in someone with airflow limitation.

The nurse is reviewing a clients lab results for PNA. Which of the following results for vancomycin would the nurse recognize as within the therapeutic range? A. 57 mcg/mL B. 44 mcg/mL C. 115 mcg/mL D. 18 mcg/mL

D. Rationale: "18 mcg/mL" is correct. The therapeutic range of vancomycin is 10-20 mcg/mL.

A nurse is caring for a client who requires a ventilator for breathing assistance. Which of the following practices would most likely reduce the risk of the client developing ventilator-associated pneumonia? A. Injecting 1 mL of saline flush into the endotracheal tube prior to suctioning B. Wearing a protective gown while providing patient care C. Changing the ventilator circuit every 12 hours D. Elevating the head of the bed

D. Rationale: "Elevating the head of the bed" is correct. Ventilator-associated pneumonia (VAP) is a potential complication of mechanical ventilation, and is a common healthcare acquired infection. Every client who is on a ventilator is at risk for developing VAP. The nurse can best prevent development of this type of pneumonia by practicing routine hand hygiene, oral cleansing of the client, and suctioning when necessary, to name a few.

The nurse is caring for a client with COPD who is admitted with pneumonia. Which of the following nursing considerations is most appropriate for this client? A. Provide supplemental oxygen at 5 L/ min via nasal cannula B. Bedrest to conserve energy C. Fluid restriction of 2L D. Encourage small, frequent meals

D. Rationale: Small frequent meals help prevent hypoxia, rather than large long meals

The nurse is caring for a client with tuberculosis and is giving report to the oncoming nurse. Which of the following statements is most appropriate? A. "The client is positive for TB and will require enteric precautions" B. "Since the client has started TB treatment, there are only 24 hours left for isolation precautions" C. "The client screened positive for TB so I have stocked surgical masks outside the room" D. "The client is positive for TB and will require airborne precautions"

D. Rationale: Tuberculosis requires airborne precautions.

A client with COPD is being seen in the primary care clinic for evaluation. During the assessment, the nurse asks the client medical history questions. Which of the following would most likely reveal whether a client is behaving in a way that works against the client's treatment plan? A. Telling the client to increase intake of dietary sodium B. Having the client perform incentive spirometry C. Explaining that the client will most likely need surgery D. Asking the client about smoking habits

D. Rationale: "Asking the client about smoking habits" is correct. Nurses often work in situations where potential ethical dilemmas take place. While assessing a client during an intake interview, a nurse may learn of information about the client that causes an ethical dilemma, which must be dealt with in some way. For example, a client with COPD may continue to smoke, thereby worsening the condition, even though this client could be using oxygen and prescriptions and care from the provider. In this case, the client's actions at home are contrary to the desire to receive care and help for COPD.

An asthmatic patient requires a short-acting bronchodilator medication during an attack to quickly resolve wheezing and to facilitate easier breathing. Which of the following medications is considered to be a short-acting bronchodilator? A.Tiotropium (Spiriva) B.Budesonide (Pulmicort) C.Nedocromil (Tilade) D.Levalbuterol (Xopenex)

D. Rationale: A short-acting bronchodilator is a medication used for temporary but rapid relief of symptoms of respiratory distress an asthma attack. These are often referred to as 'rescue inhalers' or 'relilever' medications. While this type of drug helps to facilitate easier breathing, it does not control inflammation or other factors that caused the attack in the first place. Examples of short-acting bronchodilators include levalbuterol, metaproterenol, and pirbuterol (Maxair).

After being notified that a client with bacterial PNA will be admitted to the nursing unit, the nurse should arrange to institute which type of transmission-based precautions upon the client's arrival? A. Standard B. airborne C. Enteric D. Droplet

D. Rationale: Droplet precautions are required for conditions such as pertussis and influenza.