NURS 3661 Exam 2
A nurse is evaluating the diagnostic study data of a patient with suspected cystic fibrosis (CF). Which of the following test results is associated with a diagnosis of cystic fibrosis?
Elevated sweat chloride concentration
A patient's severe asthma has necessitated the use of a long-acting beta2-agonist (LABA). Which of the patient's statements suggests a need for further education?
"I'll make sure to use this each time I feel an asthma attack coming on."
The nurse is assessing a patient who has a 35 pack-year history of cigarette smoking. In light of this known risk factor for lung cancer, what statement should prompt the nurse to refer the patient for further assessment?
"Lately, I have this cough that just never seems to go away."
A clinic nurse is caring for a patient who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The patient asks the nurse what he could have done to minimize the risk of contracting this disease. What would be the nurse's best answer?
"The most important risk factor for COPD is cigarette smoking."
A patient has just been diagnosed with lung cancer. After the physician discusses treatment options and leaves the room, the patient asks the nurse how the treatment is decided upon. What would be the nurse's best response?
"The type of treatment depends on the cell type of the cancer, the stage of the cancer, and the patient's health status."
The school nurse is presenting a class on smoking cessation at the local high school. A participant in the class asks the nurse about the risk of lung cancer in those who smoke. What response related to risk for lung cancer in smokers is most accurate?
"The younger you are when you start smoking, the higher your risk of lung cancer."
A new employee asks the occupational health nurse about measures to prevent inhalation exposure of the substances. Which statement by the nurse will decrease the patient's exposure risk to toxic substances?
"Wear protective attire and devices when working with a toxic substance."
A nurse who provides care in an ambulatory clinic integrates basic cancer screening into admission assessments. What patient most likely faces the highest immediate risk of oral cancer?
A 65-year-old man with alcoholism who smokes
The nurse is assessing a patient whose respiratory disease in characterized by chronic hyperinflation of the lungs. What would the nurse most likely assess in this patient?
A barrel chest
The nurse at a long-term care facility is assessing each of the residents. Which resident most likely faces the greatest risk for aspiration?
A resident who suffered a severe stroke several weeks ago
A patient with thoracic trauma is admitted to the ICU. The nurse notes the patient's chest and neck are swollen and there is a crackling sensation when palpated. The nurse consequently identifies the presence of subcutaneous emphysema. If this condition becomes severe and threatens airway patency, what intervention is indicated?
A tracheostomy
An asthma educator is teaching a patient newly diagnosed with asthma and her family about the use of a peak flow meter. The educator should teach the patient that a peak flow meter measures what value?
Highest airflow during a forced expiration
A patient presents to the ED stating she was in a boating accident about 3 hours ago. Now the patient has complaints of headache, fatigue, and the feeling that he "just can't breathe enough." The nurse notes that the patient is restless and tachycardic with an elevated blood pressure. This patient may be in the early stages of what respiratory problem?
Acute respiratory failure
A school nurse is caring for a 10-year-old girl who is having an asthma attack. What is the preferred intervention to alleviate this client's airflow obstruction?
Administer an inhaled beta-adrenergic agonist
The public health nurse is administering Mantoux tests to children who are being registered for kindergarten in the community. How should the nurse administer this test?
Administer intradermal injections into the children's inner forearms.
A patient who had a hemiglossectomy earlier in the day is assessed postoperatively, revealing a patent airway, stable vital signs, and no bleeding or drainage from the operative site. The nurse notes the patient is alert. What is the patient's priority need at this time?
An effective means of communicating with the nurse
A radial graft is planned in the treatment of a patient's oropharyngeal cancer. In order to ensure that the surgery will be successful, the care team must perform what assessment prior to surgery?
Assessing the patency of the ulnar artery
A perioperative nurse is caring for a postoperative patient. The patient has a shallow respiratory pattern and is reluctant to cough or to begin mobilizing. The nurse should address the patient's increased risk for what complication?
Atelectasis
A nurse is caring for a patient who has been hospitalized with an acute asthma exacerbation. What drugs should the nurse expect to be ordered for this patient to gain underlying control of persistent asthma?
Anti-inflammatory drugs
The nurse is providing discharge teaching for a patient who developed a pulmonary embolism after total knee surgery. The patient has been converted from heparin to sodium warfarin (Coumadin) anticoagulant therapy. What should the nurse teach the client?
Anticoagulant therapy usually lasts between 3 and 6 months.
When assessing for substances that are known to harm workers' lungs, the occupational health nurse should assess their potential exposure to which of the following?
Asbestos
A nurse is assessing a patient who has just been admitted to the postsurgical unit following surgical resection for the treatment of oropharyngeal cancer. What assessment should the nurse prioritize?
Assess for a patent airway.
The nurse is caring for a patient who is receiving oxygen therapy for pneumonia. How should the nurse best assess whether the patient is hypoxemic?
Assess the patient's oxygen saturation level.
A nurse is preparing to perform an admission assessment on a patient with COPD. It is most important for the nurse to review which of the following?
Available diagnostic tests
While planning a patient's care, the nurse identifies nursing actions to minimize the patient's pleuritic pain. Which intervention should the nurse include in the plan of care?
Avoid actions that will cause the patient to breathe deeply.
The nurse notes that a patient who has undergone skin, tissue, and muscle grafting following a modified radical neck dissection requires suctioning. What is the most important consideration for the nurse when suctioning this patient?
Avoid applying suction on or near the suture line.
A nurse is providing health promotion education to a patient diagnosed with an esophageal reflux disorder. What practice should the nurse encourage the patient to implement?
Avoid carbonated drinks.
A nurse is completing a focused respiratory assessment of a child with asthma. What assessment finding is most closely associated with the characteristic signs and symptoms of asthma?
Bilateral wheezes
The nurse is caring for a patient suspected of having ARDS. What is the most likely diagnostic test ordered in the early stages of this disease to differentiate the patient's symptoms from those of a cardiac etiology?
Brain natriuretic peptide (BNP) level
A nurse is reviewing the pathophysiology of cystic fibrosis (CF) in anticipation of a new admission. The nurse should identify what characteristic aspects of CF?
Bronchial mucus plugging, inflammation, and eventual bronchiectasis
A nurse is providing oral care to a patient who is comatose. What action best addresses the patient's risk of tooth decay and plaque accumulation?
Brushing the patient's teeth with a toothbrush and small amount of toothpaste
An 87-year-old patient has been hospitalized with pneumonia. Which nursing action would be a priority in this patient's plan of care?
Cautious hydration
A nurse is developing the teaching portion of a care plan for a patient with COPD. What would be the most important component for the nurse to emphasize?
Chronic inhalation of indoor toxins can cause lung damage.
A nurse is documenting the results of assessment of a patient with bronchiectasis. What would the nurse most likely include in documentation?
Clubbing of the fingers
A nurse is caring for a patient who has been admitted with an exacerbation of chronic bronchiectasis. The nurse should expect to assess the patient for which of the following clinical manifestations?
Copious sputum production
A nurse is teaching a patient with asthma about Azmacort, an inhaled corticosteroid. Which adverse effects should the nurse be sure to address in patient teaching?
Cough and oral thrush
The nurse is caring for a patient in the ICU admitted with ARDS after exposure to toxic fumes from a hazardous spill at work. The patient has become hypotensive. What is the cause of this complication to the ARDS treatment?
Hypovolemia secondary to leakage of fluid into the interstitial spaces
A student nurse is preparing to care for a patient with bronchiectasis. The student nurse should recognize that this patient is likely to experience respiratory difficulties related to what pathophysiologic process?
Dilation of bronchi and bronchioles
The nurse is caring for a patient who is scheduled for a lobectomy for a diagnosis of lung cancer. While assisting with a subclavian vein central line insertion, the nurse notes the client's oxygen saturation rapidly dropping. The patient complains of shortness of breath and becomes tachypneic. The nurse suspects a pneumothorax has developed. Further assessment findings supporting the presence of a pneumothorax include what?
Diminished or absent breath sounds on the affected side
An admitting nurse is assessing a patient with COPD. The nurse auscultates diminished breath sounds, which signify changes in the airway. These changes indicate to the nurse to monitor the patient for what?
Dyspnea and hypoxemia
The perioperative nurse is writing a care plan for a patient who has returned from surgery 2 hours prior. Which measure should the nurse implement to most decrease the patient's risk of developing pulmonary emboli (PE)?
Early ambulation
A nurse is addressing the prevention of esophageal cancer in response to a question posed by a participant in a health promotion workshop. What action has the greatest potential to prevent esophageal cancer?
Early diagnosis and treatment of gastroesophageal reflux disease
An asthma nurse educator is working with a group of adolescent asthma patients. What intervention is most likely to prevent asthma exacerbations among these patients?
Educating patients about recognizing and avoiding asthma triggers
An emergency department nurse is admitting a 3-year-old brought in after swallowing a piece from a wooden puzzle. The nurse should anticipate the administration of what medication in order to relax the esophagus to facilitate removal of the foreign body?
Glucagon
A nurse is performing health education with a patient who has a history of frequent, serious dental caries. When planning educational interventions, the nurse should identify a risk for what nursing diagnosis?
Imbalanced Nutrition: Less Than Body Requirements
A nurse is caring for a patient who is acutely ill and has included vigilant oral care in the patient's plan of care. Why are patients who are ill at increased risk for developing dental caries?
Inadequate nutrition and decreased saliva production can cause cavities
The nurse is caring for a patient at risk for atelectasis. The nurse implements a first-line measure to prevent atelectasis development in the patient. What is an example of a first-line measure to minimize atelectasis?
Incentive spirometry
A critical-care nurse is caring for a patient diagnosed with pneumonia as a surgical complication. The nurse's assessment reveals that the patient has an increased work of breathing due to copious tracheobronchial secretions. What should the nurse encourage the patient to do?
Increase oral fluids unless contraindicated.
A nurse has been asked to give a workshop on COPD for a local community group. The nurse emphasizes the importance of smoking cessation because smoking has what pathophysiologic effect?
Increases the amount of mucus production
A medical nurse who is caring for a patient being discharged home after a radical neck dissection has collaborated with the home health nurse to develop a plan of care for this patient. What is a priority psychosocial outcome for a patient who has had a radical neck dissection?
Indicates acceptance of altered appearance and demonstrates positive self-image
The case manager for a group of patients with COPD is providing health education. What is most important for the nurse to assess when providing instructions on self-management to these patients?
Knowledge about self-care and their therapeutic regimen
A nurse is caring for a young adult patient whose medical history includes an alpha1-antitrypsin deficiency. This deficiency predisposes the patient to what health problem?
Lobular emphysema
A staff educator is reviewing the causes of gastroesophageal reflux disease (GERD) with new staff nurses. What area of the GI tract should the educator identify as the cause of reduced pressure associated with GERD?
Lower esophageal sphincter
A patient has been diagnosed with a malignancy of the oral cavity and is undergoing oncologic treatment. The oncologic nurse is aware that the prognosis for recovery from head and neck cancers is often poor because of what characteristic of these malignancies?
Metastases are common and respond poorly to treatment
A patient is receiving thrombolytic therapy for the treatment of pulmonary emboli. What is the best way for the nurse to assess the patient's oxygenation status at the bedside?
Monitor pulse oximetry readings.
A firefighter was trapped in a fire and is admitted to the ICU for smoke inhalation. After 12 hours, the firefighter is exhibiting signs of ARDS and is intubated. What other supportive measures are initiated in a patient with ARDS?
Nutritional support
A patient is having pulmonary-function studies performed. The patient performs a spirometry test, revealing an FEV1/FVC ratio of 60%. How should the nurse interpret this assessment finding?
Obstructive lung disease
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 school nurse is planning a health fair for a group of fifth graders and dental health is one topic that the nurse plans to address. risk of tooth decay?
Organic fruit juice
An elderly patient comes into the emergency department complaining of an earache. The patient and has an oral temperature of 100.2oF and otoscopic assessment of the ear reveals a pearly gray tympanic membrane with no evidence of discharge or inflammation. Which action should the triage nurse take next?
Palpate the patient's parotid glands to detect swelling and tenderness.
A nurse is caring for a 6-year-old patient with cystic fibrosis. In order to enhance the child's nutritional status, what intervention should most likely be included in the plan of care?
Pancreatic enzyme supplementation with meals
A pediatric nurse practitioner is caring for a child who has just been diagnosed with asthma. The nurse has provided the parents with information that includes potential causative agents for an asthmatic reaction. What potential causative agent should the nurse describe?
Pets
A patient has undergone surgery for oral cancer and has just been extubated in postanesthetic recovery. What nursing action best promotes comfort and facilitates spontaneous breathing for this patient?
Placing the patient in Fowler's position
The nurse is caring for an 82-year-old patient with a diagnosis of tracheobronchitis. The patient begins complaining of right-sided chest pain that gets worse when he coughs or breathes deeply. Vital signs are within normal limits. What would you suspect this patient is experiencing?
Pleuritic pain
The nurse is reviewing the electronic health record of a patient with an empyema. What health problem in the patient's history is most likely to have caused the empyema?
Pneumonia
The nurse is assessing an adult patient following a motor vehicle accident. The nurse observes that the patient has an increased use of accessory muscles and is complaining of chest pain and shortness of breath. The nurse should recognize the possibility of what condition?
Pneumothorax
A patient arrives in the emergency department with an attack of acute bronchiectasis. Chest auscultation reveals the presence of copious secretions. What intervention should the nurse prioritize in this patient's care?
Postural chest drainage
A patient has been brought to the ED by the paramedics. The patient is suspected of having ARDS. What intervention should the nurse first anticipate?
Preparing to assist with intubating the patient
The nurse's comprehensive assessment of a patient includes inspection for signs of oral cancer. What assessment finding is most characteristic of oral cancer in its early stages?
Presence of a painless sore with raised edges
A patient who has had a radical neck dissection is being prepared for discharge. The discharge plan includes referral to an outpatient rehabilitation center for physical therapy. What would the goals of physical therapy for this patient include?
Promoting maximum shoulder function
A patient has undergone rigid fixation for the correction of a mandibular fracture suffered in a fight. What area of care should the nurse prioritize when planning this patient's discharge education?
Promotion of adequate nutrition
A nurse is caring for a patient who has undergone neck resection with a radial forearm free flap. The nurse's most recent assessment of the graft reveals that it has a bluish color and that mottling is visible. What is the nurse's most appropriate action?
Promptly report these indications of venous congestion.
A patient in the ICU is status post embolectomy after a pulmonary embolus. What assessment parameter does the nurse monitor most closely on a patient who is postoperative following an embolectomy?
Pulmonary arterial pressure
A patient has been diagnosed with an esophageal diverticulum after undergoing diagnostic imaging. When taking the health history, the nurse should expect the patient to describe what sign or symptom?
Regurgitation of undigested food
A nurse is caring for a patient who is postoperative day 1 following neck dissection surgery. The nurse is performing an assessment of the patient and notes the presence of high-pitched adventitious sounds over the patient's trachea on auscultation. The patient's oxygen saturation is 90% by pulse oximetry with a respiratory rat
Report this finding promptly to the physician and remain with the patient.
The home care nurse is monitoring a patient discharged home after resolution of a pulmonary embolus. For what potential complication would the home care nurse be most closely monitoring this patient?
Residual effects of compromised oxygenation
A nurse is creating a health promotion intervention focused on chronic obstructive pulmonary disease (COPD). What should the nurse identify as a complication of COPD?
Respiratory failure
A patient who involved in a workplace accident suffered a penetrating wound of the chest that led to acute respiratory failure. What goal of treatment should the care team prioritize when planning this patient's care?
Restoration of adequate gas exchange
A patient has been diagnosed with achalasia based on his history and diagnostic imaging results. The nurse should identify what risk diagnosis when planning the patient's care?
Risk for Aspiration Related to Inhalation of Gastric Contents
A nurse is developing a teaching plan for a patient with COPD. What should the nurse include as the most important area of teaching?
Setting and accepting realistic short- and long-range goals
A nursing is planning the care of a patient with emphysema who will soon be discharged. What teaching should the nurse prioritize in the plan of care?
Setting realistic short-term and long-range goals
A patient with emphysema is experiencing shortness of breath. To relieve this patient's symptoms, the nurse should assist her into what position?
Sitting upright, leaning forward slightly
A 54-year-old man has just been diagnosed with small cell lung cancer. The patient asks the nurse why the doctor is not offering surgery as a treatment for his cancer. What fact about lung cancer treatment should inform the nurse's response?
Small cell cancer of the lung grows rapidly and metastasizes early and extensively.
The nurse caring for a patient recently diagnosed with lung disease encourages the patient not to smoke. What is the primary rationale behind this nursing action?
Smoking damages the ciliary cleansing mechanism.
An x-ray of a trauma patient reveals rib fractures and the patient is diagnosed with a small flail chest injury. Which intervention should the nurse include in the patient's plan of care?
Suction the patient's airway secretions.
The nurse is caring for a 46-year-old patient recently diagnosed with the early stages of lung cancer. The nurse is aware that the preferred method of treating patients with non-small cell tumors is what?
Surgical resection
A student nurse is developing a teaching plan for an adult patient with asthma. Which teaching point should have the highest priority in the plan of care that the student is developing?
Take prescribed medications as scheduled.
A nurse is admitting a new patient who has been admitted with a diagnosis of COPD exacerbation. How can the nurse best help the patient achieve the goal of maintaining effective oxygenation?
Teach the patient strategies for promoting diaphragmatic breathing.
A nurse is providing health education to the family of a patient with bronchiectasis. What should the nurse teach the patient's family members?
The correct technique for providing postural drainage
An adult patient has tested positive for tuberculosis (TB). While providing patient teaching, what information should the nurse prioritize?
The importance of adhering closely to the prescribed medication regimen
An older adult patient has been diagnosed with COPD. What characteristic of the patient's current health status would preclude the safe and effective use of a metered-dose inhaler (MDI)?
The patient has severe arthritis in her hands.
A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett's esophagus with minor cell changes. Which of the following principles should be integrated into the patient's subsequent care?
The patient will require an upper endoscopy every 6 months to detect malignant changes.
A nurse is planning the care of a client with bronchiectasis. What goal of care should the nurse prioritize?
The patient will successfully mobilize pulmonary secretions.
The nurse is caring for a patient who has been in a motor vehicle accident and the care team suspects that the patient has developed pleurisy. Which of the nurse's assessment findings would best corroborate this diagnosis?
The patient's pain intensifies when he coughs or takes a deep breath.
A nurse is explaining to a patient with asthma what her new prescription for prednisone is used for. What would be the most accurate explanation that the nurse could give?
To gain prompt control of inadequately controlled, persistent asthma
A nurse is providing discharge teaching for a client with COPD. When teaching the client about breathing exercises, what should the nurse include in the teaching?
Use diaphragmatic breathing
A nurse in an oral surgery practice is working with a patient scheduled for removal of an abscessed tooth. When providing discharge education, the nurse should recommend which of the following actions?
Use warm saline to rinse the mouth as needed.
A nurse's assessment reveals that a client with COPD may be experiencing bronchospasm. What assessment finding would suggest that the patient is experiencing bronchospasm?
Wheezes or diminished breath sounds on auscultation