Nurs 273 Med Surg Exam 1
A nurse recognizes that a client with tuberculosis needs further teaching when the client states:
"The people I have contact with at work should be checked regularly."
Which of the following are age-related structural and functional changes that occur in the respiratory system? Select all that apply.
-decreased elasticity of the alveolar sacs -increased residual volume -increased diameter of alveolar ducts -increased thickness of alveolar sacs
You are preparing to leave the room after performing oral suctioning on a client who is on contact and airborne precautions, In which order will you perform the following actions?
1. remove gloves 2. take off goggles 3. take off gown 4. remove N95 respirator mask 5. perform hand hygiene
. The order for isoniazid (INH) reads: "give 5mg/kg PO daily". The patient weighs 275 lbs. What is the amount per dose? Is this a safe dose?
625mg No maximum dose is 300 mg
The nurse is instructing the patient on the collection of a sputum specimen. What should be included in the instructions? (Select all that apply.)
Initially, clear the nose and throat. Take a few deep breaths before coughing. Use diaphragmatic contractions to aid in the expulsion of sputum.
In caring for a patient receiving therapy with a myelosuppressive antineoplastic drug, the nurse notes an order to begin filgastim after the chemotherapy is completed. Which statement correctly describes when the nurse will begin the filgrastim therapy?
It will be initiated 24 hours after the chemotherapy is completed
A patient who is taking xanthine derivative for chronic bronchitis asks the nurse, "I miss my morning coffee. I cant wait to go home and have some" What is the nurses best response?
It's important not to take coffee or other caffeinated products with this medicine as it may cause an increased heart rate as well as other problems
The clinic nurse is caring for a client with an allergic disorder who has received the first sensitizing dose of a new drug. Now, the client is given a second dose. What nursing action is most important at this stage of transition?
Monitor the client for reactions.
A client presents to the ED with a suspected allergic reaction. The client is experiencing laryngeal edema, which is causing obstruction, and is demonstrating retractions in the neck during inspiration. Which is the nurse's priority intervention?
Prepare to administer subcutaneous epinephrine and corticosteroids.
Although the major function of the larynx is vocalization, another important function of the larynx is to:
Protect the lower airway form foreign substances
Bleeding from the drains at the surgical site or with tracheal suctioning may signal the occurrence of hemorrhage. Which of the following is a clinical manifestations associated with hemorrhage?
Rapid, deep respirations
The nurse is teaching a patient who is starting antitubercular therapy with rifampin. Which adverse effects would the nurse expect to see?
Reddish brown urine
During a teaching session for a patient who will be receiving a new prescription for the LTRA montelukast (singulair), the nurse will tell the patient that the drug has which therapeutic effect?
Reduces inflammation in the airway
A nurse is caring for a client with COPD. While reviewing breathing exercises, the nurse instructs the client to breathe in slowly through the nose, taking in a normal breath. Then the nurse asks the client to pucker his lips as if preparing to whistle. Finally, the client is told to exhale slowly and gently through the puckered lips. The nurse teaches the client this breathing exercise to accomplish which goals? Select all that apply.
Release air trapped in the lungs Prevent airway collapse Control the rate and depth of respirations
A nurse is caring for a client with COPD. The client's medication regimen has been recently changed and the nurse is assessing for therapeutic effect of a new bronchodilator. Therapeutic effects of this medication would include which of the following? Select all that apply.
Relief of dyspnea Increased expiratory flow rate
An older client doesn't understand why advancing age increases susceptibility to illness. What will be included in the nurse's explanation? Select all that apply.
The body's number of T-cell lymphocytes decreases with age. The amount of antibody produced in response to most foreign antigens decreases with age.
A nurse observes a new environmental services employee enter the room of a client with severe acute respiratory syndrome. Which action by the employee requires immediate intervention by the nurse?
The employee enters the room wearing a gown, gloves, and a mask.
During antitubercular therapy with isoniazid, the patient received another prescription for pyridoxine. Which statement by the nurse best explains the rationale for this second medication?
This vitamin helps to prevent neurological adverse effects
T/F: Immunoglobulins of the IgE class are involved in allergic disorders and some parasitic infections
True. Immunoglobulins of the IgE class are involved in allergic disorders and some parasitic infections
T/F: Latex allergy is an allergic reaction to natural rubber proteins.
True. Latex allergy is an allergic reaction to natural rubber proteins.
The nurse is caring for a client with suspected ARDS with a pO2 of 53. The client is placed on oxygen via face mask and the PO2 remains the same. What does the nurse recognize as a key characteristic of ARDS?
Unresponsive arterial hypoxemia
An older adult client who is postmenopausal informs the nurse that she believes she has developed another urinary tract infection (UTI). What risk factors do female clients in this age group have? Select all that apply.
Urinary incontinence Residual urine Estrogen deficiency
A patient is experiencing respiratory distress at home from pneumonia is brought to the hospital and upon presentation requires intubation. How would the nurse classify this pneumonia?
community acquired pneumonia
A client reports dyspnea, fatigue, and having had a persistent productive cough for the last few months, which the client attributes to a bout with the flu. The nurse suspects that this client may have:
lung cancer.
Immunocompetence is the ability of the immune system to cooperatively protect a person from external invaders and the body's own altered cells. Immunocompetence is maintained by white blood cells and:
lymphoid tissue.
Which medication was given to mr Bronson to decrease inflammation?
methylprednisone
When a patient is receiving long-term NSAID therapy, which drug may be given to prevent the serious gastrointestinal adverse effects of NSAIDs?
misopristol (Cytotec)
Which of the following represent initial signs and symptoms of a patient in respiratory distress?
-dyspnea -hypoxemia -tachypnea
Which client problems are appropriate for the nurse to include in the plan of care for the client diagnosed with COPD? Select all
-impaired gas exchange -activity intolerance
The nurse is providing teaching after an adult receives a booster immunization. Which adverse effect should be reported immediately to health care provider? Select all
-joint pain -rash over arms, back and chest -shortness of breath
When conducting a focused respiratory assessment of the client with pneumonia, which of the following are significant related assessment findings to evaluate? Select all
-quality of breath sounds in all lung fields -amount of pedal edema in bilateral extremeties -color of nail beds and oral mucosa -orientation to person, place, time, and situation
T/F: Smoking cessation is the single most cost-effective intervention to reduce the risk of developing COPD and stop its progression.
True. Smoking cessation is the single most cost-effective intervention to reduce the risk of developing COPD and stop its progression.
T/F: The T lymphocytes are primarily responsible for cellular immunity.
True. The T lymphocytes are primarily responsible for cellular immunity.
T/F: The pathophysiology of emphysema involves destruction of the walls of the alveoli leading to impaired oxygen diffusion.
True. The pathophysiology of emphysema involves destruction of the walls of the alveoli leading to impaired oxygen diffusion.
The nurse assesses the patient with sudden shortness of breath. Which finding would suggest a potential left pneumothorax?
breath sounds greater on right than left
The nurse is assessing the lungs of a patient diagnosed with pneumonia. Which of the following would be expected upon auscultation?
bronchial breath sounds
After giving an injection to a patient with HIV infection, the nurse accidentally receives a needlestick from a too full needle disposal box. Recommendations for occupational HIV exposure may include the use of which drug?
zidovudine, lamivudine, and indinavir
The patient experiencing an anaphylactic reaction may experience which of the following signs and symptoms:
-pruritis -bronchospasm -laryngeal edema -dyspnea
Vincent Brody was given morphine 2 mg IV prior to his chest tube insertion. The nurse must monitor for which of the following adverse effects with morphine administration?
-respiratory depression -bradycardia -hypotension
The nurse is monitoring a patient who has been receiving aldesleukin (IL-2) (Proleukin) for treatment of malignant melanoma. Which adverse effect, if noted on assessment, is of primary concern?
fluid retention
The nurse knows that patient with a pneumothorax would exhibit which of the following signs and symptoms?
-sudden chest pain -tachycardia -hypoxemia
Bronchodilators such as albuterol sulfate (Ventolin) are a common pharmacological treatment for patients experiencing COPD. What are adverse reactions of this drug?
-tachycardia -hypertension -tremor
The nurse is reviewing the medical history of a patient who is about to receive therapy with entaracept. Which conditions, if present, would be a contraindication or caution for therapy with this medication? Select all
-urinary tract infection - heart failure - latex allergy
Prioritize in order from highest priority to lowest priority in what order the nurse would assess these clients after having received rounds report on them prior to starting their shift.
1. An 85 year old with bacterial pneumonia. Temp 102.2 F and shortness of breath 2. A 60 yr old; post op thoracotomy requesting pain medication 3. A 35 yr old with suspected tuberculosis who has a cough 4. A 56 yr old recovering from a pulmonary embolism who is pain free
A client diagnosed with tuberculosis (TB) is taking medication for the treatment of TB. The nurse should instruct the client that he or she will be safe from infecting others approximately how long after initiation of the medication therapy?
Two to 3 weeks after initiation of bacteriocidal drugs
The nurse on a medical floor is caring for clients diagnosed with AIDS. Which client should be seen first?
The client who has flushed, warm skin with tented turgor.
The nurse is completing a client's health history with regard to potential risk factors for lung disease. What interview question addresses the most significant risk factor for respiratory diseases?
"Do you currently smoke, or have you ever smoked?"
T/F: During the first stage of HIV infection, the patient may be asymptomatic.
True. During the first stage of HIV infection, the patient may be asymptomatic.
The nurse should advise the patient who has nasal packing for epistaxis that the packing can be left in place:
Anywhere from 2 to 6 days.
The nurse is interviewing a client being admitted to the hospital and inquires about any allergies the client has. The client states he is allergic to aspirin and penicillin. What intervention should the nurse provide immediately to prevent complications related to allergies?
Apply an allergy bracelet and flag the chart.
A client with rheumatoid arthritis informs the nurse that since he has been in remission and not having any symptoms, he doesn't need to take his medication any longer. What is the best response by the nurse?
"It is important that you continue to take your medication to avoid an acute exacerbation."
The nurse is reviewing the use of multi drug therapy for HIV with a patient. Which statements are correct regarding the reason for using multiple drugs to treat HIV? Select all
-the use of multiple drugs is more effective against resistant strains of HIV -The goal of treatment is to reduce viral load -This type of therapy reduces the incidence of opportunistic infections
A 49 yr old patient has been admitted with possible chronic salicylate intoxication after self- treatment for arthritis pain. The nurse will assess for which symptoms of salicylate intoxication?
-tinnitus -headache -nausea
A public health nurse is giving an informational presentation on HIV/AIDS at a nearby college. How would the nurse best define AIDS?
Acquired mmunodeficiency syndrome (AIDS) is an infectious and potentially life-threatening disease that severely compromises the immune system.
Which type of lung cancer is the most prevalent among both men and women?
Adenocarcinoma
A patient has been diagnosed with an allergy to peanuts. What is a priority for this patient to carry at all times?
An EpiPen
The nurse is educating the patient diagnosed with acute pharyngitis on methods to alleviate discomfort. What interventions should the nurse include in the information? (Select all that apply.)
Apply an ice collar. Stay on bed rest during the febrile stage of the illness. Try a liquid or soft diet during the acute stage of the disease.
Which of the following is a clinical manifestation of a pneumothorax? Select all that apply.
Asymmetry of chest movement Sudden chest pain Unilateral retractions Oxygen desaturation
A client has been having joint pain and swelling in the left foot and is diagnosed with rheumatoid arthritis. The symptoms began suddenly without any identifiable cause, and the client has significant joint destruction. What type of disease is this considered?
Autoimmune
While planning a client's care, the nurse identifies nursing actions to minimize the client's pleuritic pain. Which intervention should the nurse include in the plan of care?
Avoid actions that will cause the client to breathe deeply.
Which of the following methods most resembles normal speech following a total laryngectomy?
Blom-Singer voice prosthesis
A client has asthma. Which of the following medications is a commonly prescribed mast cell stabilizer used for asthma?
Cromolyn sodium
Which is a late sign of hypoxia?
Cyanosis
The nurse is monitoring for liver toxicity in a patient who has been receiving long term isoniazid therapy. Manifestations of liver toxicity include:
Darkened urine Fatigue Jaundice
When the nurse is assessing the older adult patient, what gerontologic changes in the respiratory system should the nurse be aware of? (Select all that apply.)
Decreased presence of mucus Increased presence of collagen in alveolar walls Decreased gag reflex
As part of HAART therapy, a client is prescribed a non-nucleoside reverse transcriptase inhibitor (NNRTI). What would be an example of a drug from this class? Select all that apply.
Delavirdine Efavirenz
A client presents to the clinic with complaints that he began to itch and break out in hives after taking an aspirin this morning. What medication does the nurse anticipate administering that blocks histamine receptors?
Diphenhydramine
The nurse is giving an antihistamine and will observe the patient for which side effects?
Dizziness Hangover effect Drowsiness Dry Mouth
When counseling a patient who has been newly diagnosed with TB, the nurse will make sure that the patient realizes that he or she is contagious
During the initial period of the illness and its diagnosis
Late symptoms of laryngeal cancer include which of the following. Select all that apply.
Dysphagia Dyspnea Persistent hoarseness
During a routine checkup a 72 year old patient is advised to receive an influenza vaccine injection. He questions this saying "I had one last year why do I need another one?" What is an appropiate response by the nurse?
Each year a new vaccine is developed based on the flu strains that are likely to be in circulation
A nurse is planning care for a client after a tracheostomy. One of the client's goals is to overcome verbal communication impairment. Which intervention should the nurse include in the care plan?
Encourage the client's communication attempts by allowing him time to select or write words.
A patient is being educated in the use of incentive spirometry prior to having a surgical procedure. What should the nurse be sure to include in the education?
Encourage the patient to take approximately 10 breaths per hour, while awake.
A nurse is caring for a client after a thoracotomy for a lung mass. What part of the client's care is the priority for the nurse?
Gas exchange
A home health nurse is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10 breaths/minute. These signs are associated with which condition?
Hypoxia
The client with tuberculosis is being given discharge teaching instructions. Which statement made by the client indicates that the client has an understanding of the instructions:
I must stay on my medication for the full course in order to get well
The nurse is teaching a patient about the inhaler Advair (salmeterol/fluticasone). Which statements by the patient indicate a correct understanding of this medication?
I will rinse my mouth out with water after each dose This medication is taken twice a day, every 12 hours. I will call my doctor if I notice white patches inside my mouth
Bedaquiline (Sirturo) is prescribed for a patient, and the nurse is providing instructions to the patient about the medication. Which statement by the patient indicates a correct understanding of the instructions
I will take this with food
Which vaccine should a nurse encourage a client with chronic obstructive pulmonary disease (COPD) to receive?
Influenza
A client has intermittent asthma attacks. Which of the following therapies does the nurse teach the client to use at home when experiencing an asthma attack?
Inhaled albuterol (Ventolin)
A patient who currently has a chest tube in situ suddenly becomes short of breath with tracheal deviation. What does the nurse suspect has occurred?
tension pneumothorax
A patient with HIV has been on antiretroviral therapy (ART) for 6 months. The patient comes to the clinic with home medications and the nurse observes that there are too many pills in the container. What does the nurse know about the factors associated with nonadherence to ART? (Select all that apply.)
Lack of social support Depression Active substance abuse
The nursing instructor is teaching students about types of lung cancer. Which type of lung cancer is characterized as fast growing and can arise peripherally?
Large cell carcinoma
For a client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the care plan?
Measuring and documenting the drainage in the collection chamber
__________ are the first cells to arrive at the site in the body where inflammation occurs.
Neutrophils
Pulmonary Diffusion is the process by which:
Oxygen and Carbon Dioxide are exchanged from areas of a higher Concentration to a lower concentration
A patient is taking a decongestant to help reduce symptoms of a cold. The nurse will instruct the patient to observe for which possible symptom, which may indicate an adverse effect of this drug
Palpitations
A nurse is exposed to hepatitis C and receives a shot of gamma globulin. What type of immunity does this nurse have?
Passive immunity
SpO2 oxygen saturation is:
Percentage of hemoglobin that is bound to oxygen
A nurse educator is reviewing the indications for chest drainage systems with a group of medical nurses. What indications should the nurses identify? Select all that apply.
Post thoracotomy Spontaneous pneumothorax Chest trauma resulting in pneumothora
The nurse is teaching the client in respiratory distress ways to prolong exhalation to improve respiratory status. The nurse tells the client to
Purse the lips when exhaling air from the lungs.
A patient comes to the clinic with fever, cough, and chest discomfort. The nurse auscultates crackles in the left lower base of the lung and suspects that the patient may have pneumonia. What does the nurse know is the most common organism that causes community-acquired pneumonia?
Streptococcus pneumoniae
An x-ray of a trauma client reveals rib fractures and the client is diagnosed with a small flail chest injury. Which intervention should the nurse include in the client's plan of care?
Suction the client's airway secretions.
T/F: The major cause of death in ARDS is non pulmonary multiple organ dysfunction syndrome, often with sepsis
True
A patient who has been newly diagnosed with HIV has many questions about the effectiveness of drug therapy. After a teaching session, which statement by the patient reflects a need for more education?
These drugs will eventually eliminate the virus from my body
A client with chronic bronchitis is admitted with an exacerbation of symptoms. During the nursing assessment, the nurse will expect which of the following findings? Select all that apply.
Use of accessory muscles to breathe Purulent sputum with frequent coughing
A client is recovering from an attack of gout. What will the nurse include in the client teaching?
Weight loss will reduce uric acid levels and reduce stress on joints.
While auscultating the lungs of a client with asthma, the nurse hears a continuous, high-pitched whistling sound on expiration. The nurse will document this sound as which of the following?
Wheezes
The nurse should include which statement when providing education once the patient is first stabilized after an anaphylactic reaction?
You will be closely monitored since there is a chance of delayed reaction
Which client should be seen by the nurse first after having received shift report.
a 45 yr old diagnosed with pneumonia with a pulse oximetry reading of 80%
A child who contracts chickenpox at age 5 has developed which type of immunity?
active acquired, natural
The nurse understands that tidying in the patient assessment chamber of a test tube is which type of finding?
air leak
The client is admitted with a diagnosis of rule-out tuberculosis. Which type of isolation should the nurse implement
airborne precautions
During treatment with zidovudine the nurse needs to monitor for which potential adverse effect?
bone marrow suppression
___________ is a fungal infection that occurs in almost all patients with AIDS and immune depression
candidiasis
Clear fluid draining from either nostril of the nose suggests a fracture of the cribriform plate with leakage of _______________ fluid.
cerebrospinal
The client has a pulse oximeter reading of 91%. The nurse should implement which of the following measures first?
change the finger the pulse ox is on
After surgery for organ transplantation, a patient is receiving ganciclovir, even though he does not have a viral infection. Which statement best explains the rationale for this medication therapy?
ganciclovir is given to prevent CMV infection
During a teaching session about antigout drugs, the nurse tells the patient that antigout drugs work by which mechanism?
decreasing serum uric acid levels
During assessment of the respiratory system, the nurse inspects and palpates the trachea in order to assess: trachea?
deviation from the midline.
COPD is generally characterized by the presence of three symptoms: chronic cough, sputum production and ______
dyspnea
Two frequent priority clinical manifestations associated with a pulmonary embolism are ______ and ______
dyspnea and chest pain
The nurse is administering intravenous vancomycin. What will the nurse initially assess the client for if an allergic reaction occurrs?
dyspnea, bronchospasm, and/or laryngeal edema
A client is admitted to your nursing unit with symptoms of pneumonia. The client has not responded well to treatment with antibiotics. The client's sputum culture & sensitivity and CXR conclude that the client has pneumocystis jiroveci pneumonia. The nurse should conclude that the client:
has acquired immunodeficiency syndrome (AIDS)
The most serious postoperative complication of a tonsillectomy is ____________
hemorrhage
A nurse is working in a dermatology clinic with clients who have allergies. What is the most important chemical mediator involved in the allergic response?
histamine
The nurse is administering methotrexate as part of the treatment for rheumatoid arthritis and will monitor for which sign of bone marrow suppression?
increased bleeding tendencies
______ allergy is an allergic reaction to natural rubber proteins
latex
Influenza and ____________ are the most common causes of death from infectious diseases in the United States.
pneumonia
If a rapid onset of shortness of breath occurs in a client with COPD, the nurse should quickly evaluate the client for the potential complication of a ____________ by assessing the symmetry of chest movements, differences in breath sounds and pulse oximetry.
pneumothorax
crackles
popping sound during inspiration from fluid or delayed opening of collapsed alveoli
The client diagnosed with rheumatoid arthritis is being seen in the outpatient clinic. Which preventative care should the nurse include in the regularly scheduled
recommend the flu and pneumonia vaccines
A PCA/UAP has taken the vital signs of a client who has a tracheostomy. Which vital sign is of the priority when reporting these vital signs to the nurse?
tympanic temperature of 101.4
The nurse is reviewing the medical history of a patient who is about to receive therapy with etanercept (Enbrel). Which condition if present would be a contraindication or causation for therapy with this drug?
urinary tract infection
A client with early-stage rheumatoid arthritis asks the nurse what he can do to help ease the symptoms of his disease. What would be the best response by the nurse?
"The doctor could prescribe anti-inflammatory drugs."
The nurse is counseling a woman who is beginning antitubercular therapy with rifampin. The patient also takes an oral contraceptive. Which statement by the nurse is most accurate regarding potential drug interactions?
You will need to switch to another form of birth control while you are taking the rifampin
While monitoring a patient, the nurse knows that a therapeutic response to antitubercular drugs would be:
There is a decrease in symptoms along with improved chest radiograph and sputum culture results.
When the nurse is teaching a patient who is taking acyclovir for genital herpes, which statement by the nurse is accurate?
This drug will help the lesions to dry and crust over
The nurse sees that in the client's respiratory assessment the nail beds are described: "presence of clubbing". This finding indicates:
This may indicate chronic hypoxia and/or lung cancer.
T/F: A significant (positive) reaction on the Mantoux tuberculin skin test does not necessarily mean that active diseases is present in the body
True
A client developed a rash on their trunk and bilateral arms. They started taking an antibiotic that had been prescribed 5 days ago. The nurse knows that this is most likely a:
Type IV Hypersensitivirt reaction
In the emergency department several patients have possibly been exposed to anthrax. The nurse will prepare to administer prophylactic doses of.
ciprofloxacin
The nurse observes the PCA/UAP entering an isolation room and leaving the door open. Which action by the nurse is the best response?
close the door and discuss the PCA's action after coming out of the room
When the nurse is teaching about antigout drugs , which statement by the nurse is accurate?
colchicine is best taken on an empty stomach
The nurse notes in a patient's medication history that the patient is taking benzoate (tessalon perles) as needed. Based on this finding the nurse interprets that the patient has which problem?
cough
A client has had a total laryngectomy. The client has poor eye contact, refuses visitors and appears to be withdrawn. Which nursing intervention would be the nursing priority at this time for this client?
encourage expression of feelings via an alternate means of communication
When planning care for a patient who is receiving interferon therapy, the nurse must keep in mind that the major dose-limiting factor is
fatigue
A complication of blunt chest trauma caused by injury from the steering wheel during a motor vehicle accident is called a _________ chest
flail
A client with end-stage acquired immunodeficiency syndrome (AIDS) has profound manifestations of Cryptosporidium infection caused by the protozoa. What client need should in the nurse focus on when planning this client's care?
fluid replacement
Postoperative nursing management of the client following a radical neck dissection for laryngeal cancer requires:
frequent suctioning of the laryngectomy tube
bronchophony, egophony,
increased lung density from pneumonia & pulmonary edema
Proteins formed when cells are exposed to viral or foreign agents that are capable of activating other components of the immune system are referred to as
interferons
The nurse is working with a client with allergies. What will the nurse use to confirm allergies and decrease the risk of anaphylaxis?
intradermal testing
A nurse is discussing autoimmune disease with a class of nursing students. Which signs and symptoms are shared by rheumatoid arthritis and systemic lupus erythrematosus (SLE)?
joint stiffness and pain
A nurse is caring for a client who recently underwent a tracheostomy. The first priority when caring for a client with a tracheostomy is:
keeping his airway patent.
Mother to child transmission of HIV- may occur in utero, during _______, through breastfeeding.
labor
A client has just undergone bronchoscopy. Which initial nursing assessment is the priority at this time?
level of conciousness
The nurse recognizes that manifestations of NSAID toxicity include:
nausea and vomitting
The nurse understands which of the following is the most common cause of anaphylaxis:
penicillin
When assessing a patient who will be receiving a measles vaccine, the nurse will consider which condition to be a possible contraindication?
pregnancy
The client is postoperative for a total laryngectomy and has recovered from anesthesia. The client's respirations are 32 breaths/minute, blood pressure is 102/58, and pulse rate is 104 beats/minute. Pulse oximetry is 90%. The client is receiving humidified oxygen. To aid in the client's respiratory status, the nurse places the client in which of the following positions.
semi fowlers
Which of the following does the nurse suspect as the most likely cause for a pneumothorax in a patient diagnosed with severe emphysema?
severe coughing episode
The CDC recommends the pneumococcal vaccine (Pneumovax 23) for which group of patients?
smokers between ages 19 and 64 years of age
What risk factor does the nurse recognize that the patient had related to pneumonia?
smoking
When giving a vaccination to an infant, the nurse should tell the mother to expect which adverse effect?
soreness at the injection site
Patients who have difficulty coordinating inspiration with activation of their metered dose inhaler can be helped by the use of a __________
spacer
Epinepherine is administered for Kenneth Bronson anaphylactic reaction. Which does the nurse know is a possible side effect of this drug?
tachycardia
_________ is a type 1 hypersensitive allergic reaction of the skin characterized by the sudden appearance of pinkish, edematous elevations that vary in size and shape, itch and cause local discomfort
urticaria
____________ the most common cause of upper respiratory infections, affect the upper respiratory passages and lead to subsequent mucous membrane inflammation.
viruses
Once the patient is stable after an anaphylactic reaction, what information would be most essential for the nurse to include with patient and family follow up teaching?
what caused the event and how to prevent
The nurse is auscultating lung sounds. What lung sound is associated with narrowing of the airway?
wheezes- high pitch musical sounds associated with airway narrowing
A mother calls to ask what medications to give her 5 year old child for a fever during a bout of chickenpox. The nurses best response would be:
you can use children disagrees of acetaminophen or ibuprofen, but aspirin is not recommended
Which of the following is used intravenously to maintain blood pressure in a patient experiencing hypotension during an anaphylactic reaction?
- epinephrine -normal saline
Which of the following are initial assessments the nurse understands as potential signs and symptoms of a pneumothorax?
-asymmetrical chest wall movement -tachypnea -dyspnea
When a patient presents to the emergency department with pneumonia which signs and symptoms would the nurse expect the patient to exhibit?
-orthopnea -fever -dyspnea -fatigue
When performing endotracheal suctioning, the nurse applies suctioning while withdrawing and gently rotating the catheter 360 degrees for how long?
10 to 15 seconds
A patient has been given an MDI of albuterol and is instructed to take 2 puffs three times a day, with doses 6 hrs apart. The inhaler contains 200 actuations but does not have a dose counter. Calculate how many days the inhaler will deliver this ordered dose.
33 days
The development of a positive HIV antibody test following initial infection generally occurs in which timeframe?
4 weeks
The order for a 4 yr old patient reads: "give guafenesin 80mg PO q4h PRN for cough. Maximum of 600mg/24hrs" The medication comes in a bottle that has 100 mg/5mL. How many mL will the nurse give per dose?
4mL
A patient with COPD requires oxygen administration. What method of delivery does the nurse know would be best for this patient?
A Venturi mask
A patient who has a history of asthma is experiencing an acute episode of shortness of breath and needs to take a medication for immediate relief. The nurse will choose which medication that is appropriate for this situation?
A beta agonist, such as albuterol
The nurse knows that an antitussive cough medication would be the best choice for which patient?
A patient who has had recent abdominal surgery
Which client is more at risk of becoming infected with human immunodeficiency virus (HIV)?
A person having casual intercourse with multiple partners
A client is given a dose of ketorolac, a nonsteroidal anti-inflammatory drug for complaints of abdominal pain. Ten minutes after receiving the medication, the client's eyes, lips, and face begin to swell, and the nurse hears stridor. What priority measure should the nurse prepare to do?
Administer epinephrine.
The nurse is caring for a client following a wedge resection. While the nurse is assessing the client's chest tube drainage system, constant bubbling is noted in the water seal chamber. This finding indicates which problem?
Air leak
The nurse is an occupational health nurse who is presenting a workshop on laryngeal cancer. What risk factors would the nurse be sure to include in the workshop? Select all that apply.
Alcohol Tobacco Industrial pollutants
A client with cystic fibrosis has received a double lung transplant and is now experiencing signs of rejection. What is the immune response that predominates in this situation?
Cellular
The nurse is educating a patient diagnosed with acute bacterial rhinosinusitis about interventions that may assist with symptom control. What should the nurse include in this information? (Select all that apply.)
Ensure an adequate fluid intake. Increase the humidity in the home. Apply local heat to promote drainage.
After a nebulizer treatment with the beta agonist albuterol, the patient complains of feeling a little shaky, with slight tremors of the hands. The patient's heart rate is 98 BPM increased from the pretreatment rate of 88 BPM. The nurse knows this reaction is an:
Expected adverse effect of the medication
The nurse is reviewing a patients medication orders for prn meds that can be given to a patient who has bronchitis with a productive cough. Which drug will the nurse choose?
Expectorant
The nurse has been caring for a client who has been prescribed an antibiotic for pharyngitis and has been instructed to take the antibiotic for 10 days. One day 4, the client is feeling better and plans to stop taking the medication. What information should the nurse provide to this client?
Finish all the antibiotics to eliminate the organism completely.
The ED nurse is assessing a young gymnast who fell from a balance beam. The gymnast presents with a clear fluid leaking from her nose. What should the ED nurse suspect?
Fracture of the cribriform plate
The nurse is educating the patient in the use of a mini-nebulizer. What should the nurse encourage the patient to do? (Select all that apply.)
Frequently evaluate progress. Cough frequently. Hold the breath at the end of inspiration for a few seconds.
When assessing a patient who is to receive a decongestant, the nurse will recognize that a potential contraindication to this drug would be which condition?
Glaucoma
When giving decongestants, the nurse must remember that these drugs have alpha-adrenergic-stimulating effects that may result in which effect?
Hypertension
A client diagnosed with asthma is preparing for discharge. The nurse is educating the client on the proper use of a peak flow meter. The nurse instructs the client to complete which action?
If coughing occurs during the procedure, repeat it.
A client with acquired immunodeficiency syndrome (AIDS) develops Pneumocystis cariniipneumonia. Which nursing diagnosis has the highest priority?
Impaired gas exchange
A client comes to the emergency department complaining of difficulty breathing. He states, "It feels like my throat is closing up. We were out to dinner and then I started feeling strange after we ate our shrimp cocktail." The client is leaning forward with a respiratory rate of 36 breaths per minute. His skin is pale. The nurse suspects anaphylaxis. Which nursing diagnosis would be the priority?
Ineffective airway clearance related to bronchospasm and laryngeal edema
A medical nurse has admitted a client to the unit with a diagnosis of failure to thrive. The client has developed a fever and cough, so a sputum specimen has been obtained. The nurse notes that the sputum is greenish and that there is a large quantity of it. The nurse notifies the client's physician because these symptoms are suggestive of what?
Infection
Which of the following interventions would be helpful for a client reporting nasal congestion, sneezing, sore throat, and muscle aches? Select all that apply.
Provide warm salt-water gargles. Administer oral ibuprofen. Teach the client about handwashing. Recommend guaifenesin.
A nursing student understands that emphysema is directly related to which of the following?
Respiratory acidosis from airway obstruction
A client presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands that goals of therapy should be achieved to improve the client's condition. Which statements reflect therapy goals? Select all that apply.
Return the client to their original functioning abilities. Provide medical support for the current exacerbation. Provide long-term support for medical management. Treat the underlying cause of the event.
After the patient takes a dose of an inhaled corticosteroid, such as fluticasone (Flovent), what is the most important action the patient needs to do next?
Rinse out the mouth with water
A 40-year-old woman was diagnosed with Raynaud phenomenon several years earlier and has sought care because of a progressive worsening of her symptoms. The client also states that many of her skin surfaces are "stiff, like the skin is being stretched from all directions." The nurse should recognize the need for medical referral for the assessment of what health problem?
Scleroderma
A nurse is completing a nutritional status of a client who has been admitted with AIDS-related complications. What components should the nurse include in this assessment? Select all that apply.
Serum albumin level Weight history Blood urea nitrogen (BUN) level Body mass index
A patient has been receiving aminophylline (xanthine derivative) infusion for 24 hours. The nurse will assess for which adverse effect when assessing the patient during the infusion?
Sinus tachycardia
The nurse caring for a client recently diagnosed with lung disease encourages the client not to smoke. What is the primary rationale behind this nursing action?
Smoking damages the ciliary cleansing mechanism.
Which intervention should the nurse implement to manage pain for the client with rheumatoid arthritis? Select all that apply.
Support joints with splints and pillows. Provide diversional activities. Provide opportunities for the client to verbalize feelings.
A client with asthma has developed obstruction of the airway. Which of the following does the nurse understand as having potentially contributed to this problem? Choose all that apply.
Swelling of bronchial membranes Airway remodeling Thick mucus
What types of cells are the primary participants in immune response? Select all that apply.
T-cell lymphocytes B-cell lymphocytes
A 28 year old is in the urgent care after stepping on a rusty tent nail. The nurse evaluates the patients immunity status and notes that the patient thinks she had her last tetanus booster about 10 years ago, just before starting college. Which immunization would be most appropriate at this time?
Tdap
The nurse is teaching the client with HIV about therapy. Which elements are essential for the nurse to include in the teaching plan? Select all that apply.
The CD4 count is the major indicator of immune function and guides therapy. Antiretroviral therapy targets different stages of the HIV life cycle.
After suctioning a tracheostomy tube, the nurse assesses the client to determine the effectiveness of the suctioning. Which findings indicate that the airway is now patent?
Effective breathing at a rate of 16 breaths/minute through the established airway
The diagnosis of pulmonary hypertension associated with chronic obstructive pulmonary disease (COPD) is suspected when which of the following is noted? Select all that apply.
Elevated plasma brain natriuretic peptide (BNP) Right ventricular enlargement Dyspnea and fatigue disproportionate to pulmonary function abnormalities Enlargement of central pulmonary arteries
An office worker takes a cookie that contains peanut butter. The worker begins wheezing, with an inspiratory stridor and air hunger and the occupational health nurse is called to the office. The nurse should recognize that the worker is likely suffering from which type of hypersensitivity?
Anaphylactic (type 1)
Which is the most important risk factor for development of chronic obstructive pulmonary disease (COPD)?
Cigarette smoking
___________, one type of biologic response modifier, is a nonspecific viricidal protein that is naturally produced by the body and is capable of activating other components of the immune system
Interferon
The nurse is conducting a class on drugs for malignant tumors for a group of new oncology staff members. Which best describes the action of interferons in the management of malignant tumors?
Interferons have antiviral and anti tumor properties and strengthen the immune system
The nurse administering diphenhydramine understands that the medication falls under which of the following categories for the treatment of an anaphylactic reaction?
antihistamine
What is the priority action by the nurse when a patient experiences sudden respiratory distress?
assess airway
When a patient develops respiratory distress what is the appropriate 1st action for the nurse to take to address this specific concern
assess airway, breathing, circulation and auscultate lungs
A nurse enters a client's room and observes a container with sputum. Upon questioning about the specimen, which information from the client would necessitate the nurse to obtain a new specimen?
"I coughed that up about 8 hours ago."
A client is being treated in the ED for respiratory distress coupled with pneumonia. The client has no medical history. However, the client works in a coal mine and smokes 10 cigarettes a day. The nurse anticipates which order based on the client's immediate needs?
Administration of antibiotics
Which of the following are risk factors for the development of chronic obstructive pulmonary disease (COPD)? Select all that apply.
Air pollution Second-hand smoke Occupational dust Tobacco smoke Infection
A nurse is assessing a client who is suspected of having bronchiectasis. The nurse should consider which of the following potential causes? Select all that apply.
Airway obstruction Pulmonary infections Genetic disorders
A client's spouse states that she is worried about her husband because he appears to be breathing "really hard." The nurse performs a respiratory assessment. What findings would indicate a need for further interventions?
BP 122/80, HR 116, R 24, pale and clammy skin, temp 101.3 °F (38.5 °C)
A client with newly diagnosed emphysema is admitted to the medical-surgical unit for evaluation. Which does the nurse recognize as a deformity of the chest wall that occurs as a result of overinflation of the lungs in this client population?
Barrel chest
Which assessment finding would be most consistent with advanced emphysema?
Barrel-shaped chest
The nurse is caring for an adolescent client injured in a snowboarding accident. The client has a head injury, a fractured right rib, and various abrasions and contusions. The client has a blood pressure of 142/88 mm Hg, pulse of 102 beats/minute, and respirations of 26 breaths/minute. Which laboratory test best provides data on a potential impairment in ventilation?
Blood gases
A thoracentesis is performed to obtain a sample of pleural fluid or a biopsy specimen from the pleural wall for diagnostic purposes. What does serous fluid indicate?
Cancer
An 87-year-old client has been hospitalized with pneumonia. Which nursing action would be a priority in this client's plan of care?
Cautious hydration
Which term refers to lung tissue that has become more solid in nature as a result of a collapse of alveoli or an infectious process?
Consolidation
An elderly client is diagnosed with pulmonary tuberculosis. Upset and tearful, he asks the nurse how long he must be separated from his family. Which nursing diagnosis is most appropriate for this client?
Deficient knowledge (disease process and treatment regimen)
A nurse is caring for an older adult with pneumonia. What are age-related structural and functional changes that occur in the respiratory system? Select all that apply.
Increased diameter of alveolar ducts Increased residual volume Increased thickness of alveolar sacs Decreased elasticity of the alveolar sacs
The nurse is planning the care for a client at risk of developing pulmonary embolism. What nursing interventions should be included in the care plan? Select all that apply.
Instructing the client to move the legs in a "pumping" exercise Applying a sequential compression device Using elastic stockings, especially when decreased mobility would promote venous stasis Encouraging a liberal fluid intake
The occupational health nurse is obtaining a client history during a pre-employment physical. During the history, the client states that he has hereditary angioedema. The nurse should identify what implication of this health condition?
It can cause life-threatening airway obstruction.
The nurse is caring for a client who needs education on his medication therapy for allergic rhinitis. The client is to take cromolyn daily. In providing education for this client, how should the nurse describe the action of the medication?
It inhibits the release of histamine and other chemicals.
Which community-acquired pneumonia demonstrates the highest occurrence during summer and fall?
Legionnaires disease
A client has just undergone bronchoscopy. Which nursing assessment is most important at this time?
Level of consciousness
Why would a client with COPD report feeling fatigued? Select all that apply.
Lung function gradually decreases over time in clients with COPD. The client is using all expendable energy just to breathe.
The nurse is caring for a client who is demonstrating signs of increased respiratory distress related to laryngeal obstruction. The nurse is calling the physician to report on the client's condition. Which of the following will the nurse report? Select all that apply.
Lung sounds of wheezing Increased respiratory effort Arterial blood gases reporting a PaCO2 of 48 and a PaO2 of 84 Nasal flaring with abdominal retractions
A client with severe combined immunodeficiency disease is receiving immunosuppression therapy to ensure engraftment of depleted bone marrow during transplantation procedures. What is the priority nursing care for this client?
Meticulous infection control precautions
Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply.
Montelukast Zafirlukast Zileuton
The nurse identifies which finding to be most consistent prior to the onset of acute respiratory distress?
Normal lung function
During an annual examination, an older client tells the nurse, "I don't understand why I need to have so many cancer screening tests now. I feel just fine!" Based on knowledge of neoplastic disease and the aging immune system, what teaching should the nurse include in the client's plan of care? Select all that apply.
Nutritional intake to support a competent immune response plays an important role in reducing the incidence of cancer. A healthy diet including protein, vitamins, minerals, and some fats can alter the risk of cancer development. The increase in occurrence of autoimmune diseases with aging strongly suggests a predisposition toward various types of cancer due to the body's inability to differentiate between self and nonself. Routine screening increases the chance of finding and treating cancer early. Tumor cells may possess special blocking factors that coat tumor cells and prevent their destruction by killer T lymphocytes; therefore the body may not recognize the tumor as foreign and fail to destroy the malignant cells. Routine screening increases the chance of finding and treating cancer early.
A gerontologic nurse is teaching a group of medical nurses about the high incidence and mortality of pneumonia in older adults. What is a contributing factor to this that the nurse should describe?
Older adults often lack the classic signs and symptoms of pneumonia.
The nurse is caring for a client with hypoxemia of unknown cause. Which of the following oxygen transport considerations does the nurse identify as crucial to circulate oxygen in the body system? Select all that apply.
Oxyhemoglobin circulates to the body tissue. Adequate red blood cells are needed for oxygen transport. Oxygen is dissolved.
A client suspected of developing acute respiratory distress syndrome (ARDS) is experiencing anxiety and agitation due to increasing hypoxemia and dyspnea. A nurse would implement which intervention to improve oxygenation and provide comfort for the client?
Position the client in the prone position
The client is prescribed albuterol 2 puffs as a metered-dose inhaler. Which action by the client demonstrates understanding of administration for this medication?
Positions the inhaler 2 finger widths away from the lips
A nurse is caring for a client with COPD. While reviewing breathing exercises, the nurse instructs the client to breathe in slowly through the nose, taking in a normal breath. Then the nurse asks the client to pucker his lips as if preparing to whistle. Finally, the client is told to exhale slowly and gently through the puckered lips. The nurse teaches the client this breathing exercise to accomplish which goals? Select all that apply.
Prevent airway collapse Release air trapped in the lungs Control the rate and depth of respirations
A client presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands that goals of therapy should be achieved to improve the client's condition. Which statements reflect therapy goals? Select all that apply.
Provide medical support for the current exacerbation. Return the client to their original functioning abilities. Provide long-term support for medical management. Treat the underlying cause of the event.
A client with Crohn's disease, an autoimmune disorder, informs the nurse that he has not had any symptoms of the disease in 8 months. What does the nurse understand this asymptomatic period is referred to?
Remission
A client has a nursing diagnosis of ineffective airway clearance related to excessive mucus production. The best short-term goal is for the client to
Report decreased congestion.
A client has been classified as status asthmaticus. The nurse understands that this client will likely initially exhibit symptoms of:
Respiratory alkalosis
The diagnosis of pulmonary hypertension associated with chronic obstructive pulmonary disease (COPD) is suspected when which of the following is noted? Select all that apply.
Right ventricular enlargement Elevated plasma brain natriuretic peptide (BNP) Enlargement of central pulmonary arteries Dyspnea and fatigue disproportionate to pulmonary function abnormalities
A client comes to the ED and is admitted with epistaxis. Pressure has been applied to the client's midline septum for 10 minutes, but the bleeding continues. The nurse should anticipate using what treatment to control the bleeding?
Silver nitrate application
A nurse is responsible for monitoring indicators of potential complications after laryngectomy. Which indicators would be priority concerns? Select all that apply.
Somnolence and hypotension Tachycardia and tachypnea Impaired swallowing Persistent high tracheostomy cuff pressure
Bacterial infection occurs in about 70% of those who have acute rhinosinusitis. The nurse is aware that the least common bacteria is:
Staphylococcus aureus
The nursing instructor is discussing the development of human immunodeficiency disease (HIV) with the students. What should the instructor inform the class about helper T cells?
They are activated on recognition of antigens and stimulate the rest of the immune system.
Once the patient has been cleared for oral feedings, post laryngectomy, the nurse knows to prepare:
Thick liquids that are easy to swallow.
A client with asthma has developed obstruction of the airway. Which of the following does the nurse understand as having potentially contributed to this problem? Choose all that apply.
Thick mucus Airway remodeling Swelling of bronchial membranes
T-cell deficiency occurs when which gland fails to develop normally during embryogenesis?
Thymus
A client presents to the walk-in clinic reporting a dry, irritating cough and production of a small amount of mucus-like sputum. The client also reports soreness in her chest in the sternal area. The nurse should suspect that the primary care provider will assess the client for what health problem?
Tracheobronchitis
The occupational health nurse is assessing an employee who has just had respiratory exposure to a toxin. What should the nurse assess? Select all that apply.
Type of respiratory protection used Time frame of exposure Intensity of exposure Breath sounds
The nurse is planning for the care of a client with acute tracheobronchitis. What nursing interventions should be included in the plan of care? Select all that apply.
Using cool-vapor therapy to relieve laryngeal and tracheal irritation Increasing fluid intake to remove secretions Encouraging the client to rest
The nurse is planning the care for a client at risk of developing pulmonary embolism. What nursing interventions should be included in the care plan? Select all that apply.
Using elastic stockings, especially when decreased mobility would promote venous stasis Applying a sequential compression device Instructing the client to move the legs in a "pumping" exercise Encouraging a liberal fluid intake
The nurse is caring for a patient in the hospital who is receiving a vitamin D supplement. What does the nurse understand is the importance of supplementation with this vitamin? (Select all that apply.)
Vitamin D deficiency is associated with increased risk of inflammatory disorders. Vitamin D deficiency is associated with increased risk of autoimmune disease. Vitamin D deficiency is associated with increased risk of common cancers.
A client who has recently started working in a coal mine is concerned the effects on long-term health. How does the nurse advise the client to prevent occupational lung disease? Select all that apply.
Wear appropriate protective equipment when around airborne irritants and dusts. Do not smoke, or quit smoking if currently smoking.
A client is prescribed antihistamines, and asks the nurse about administration and adverse effects. The nurse should advise the client to avoid:
alcohol
Understanding pulmonary physiology, what characteristic would the nurse expect to result in decreased gas exchange in older adults?
alveolar walls containing fewer capillaries
A client who underwent thoracic surgery to remove a lung tumor had a chest tube placed anteriorly. The surgical team places this catheter to:
remove air from the pleural space.
