NURS310 Exam Two

Now that Mr. Walsh is on his nebulizer treatment, you would like to evaluate his other symptoms. What is one potential cause of Mr. Walsh's complaints of headache, sore throat, and palpitations?

Albuterol overdose

A patient presents with manifestations of wheezing and difficulty breathing after picking wildflowers in the yard. Which is the most likely cause of the asthmatic symptoms?

Allergic hypersensitivity reaction to the flowers

An 8-year-old child is admitted to the hospital for asthma. Which diagnostic test should the nurse expect to be ordered for this patient?

Allergy skin testing

The public health nurse is providing community education aimed at promoting nutritional habits that decrease an​ individual's modifiable risk factors for heart disease. Which topics should the nurse include in this teaching​ session? Select all that apply.

Benefits of consuming fruits and vegetables Preparing balanced meals Selecting lean protein sources Strategies for maintaining recommended daily caloric intake

The parent of a child recently diagnosed with cystic fibrosis (CF) states that they are overwhelmed with caring for the child and that they do not know what to do next. Which suggestion should the nurse provide to incorporate elements of family-oriented care for this child?

Bring the family together for a teaching session.

You decide to increase Mr. Walsh's oxygen flow to 6 L/min and consult his provider about additional medications to administer. When you discuss Mr. Walsh's condition with the provider, what drug class would you anticipate him ordering?

Corticosteroid

The nurse is assessing a patient with cystic fibrosis (CF). The nurse observes that the patient coughed into their sleeve and then wiped the mouth with the back of the hand. Which patient teaching should help to prevent the spread of infection?

Coughing into a tissue, disposing of it immediately, then using an alcohol-based gel

A couple visits the clinic to discuss family planning and inform the nurse of having a distant cousin with cystic fibrosis. Which diagnostic test should the nurse expect the healthcare provider to order?

Cystic fibrosis transmembrane conductance regulator (CFTR)

The nurse is caring for an older adult client. The client tells the nurse that he is constipated. What is the​ nurse's initial​ action?

Determine what the client means by constipation.

To address the patient's dyspnea, the provider has ordered 500 mcg (1 vial of 0.02% solution) ipratropium (Atrovent) via nebulizer. Based on provider orders, which tests will you need to administer to monitor drug effectiveness?

FVC (Forced Vital Capacity) FEV1 (Forced Expiratory Volume, 1 sec) PEF (Peak Expiratory Flow)

Which condition should the nurse recognize as being more common in a pregnant woman with cystic fibrosis?

Gestational diabetes

After teaching an 8-year-old child how to use an inhaler, the nurse observes that the child places the mouthpiece between the teeth, closes the lips, breathes in gently and deeply, and then presses down on the canister to release the medication into the spacer. Which action by the nurse would be most appropriate?

Having the child demonstrate again while providing instructions to correct the errors from their first demonstration

The nurse is preparing educational materials for a client with hypertension. Which of the following elements should the nurse include when preparing this​ material? Select all that apply.

Helping the client to recognize foods that are low in sodium Showing the client how to follow the DASH eating plan Teaching the client how to read nutritional labels Explaining the effects of sodium on blood pressure

The parent of an adolescent with cystic fibrosis (CF) states that the child has low energy and refuses to finish meals. Which type of diet should the nurse recommend for the patient?

High-calorie, high-fat diet

Which dietary intervention should the nurse discuss with a patient diagnosed with cystic fibrosis (CF)?

High-calorie, high-fat diet

What important question(s) should you ask Mr. Walsh about his albuterol use before you administer additional medications?

How many puffs of albuterol do you take daily on average? When was the last time you took a dose of albuterol?

The nurse is teaching a patient who was recently diagnosed with asthma about allergy testing results that indicate the patient is allergic to dust mites. Which expected outcome is appropriate for this patient following the teaching?

The patient uses furniture covers and a mattress pad to cover the bed to prevent exposure.

A client presents with acute constipation for the second time in two months. The physician orders a diagnostic barium enema. Based on the testing​ order, the nurse understands that the​ client's condition is likely associated​ with:

The structure of the bowel or the presence of tumors or diverticula.

The nurse is teaching an adolescent with cystic fibrosis (CF) about the purpose of weight-bearing exercise. Which purpose should the nurse provide for this activity?

To decrease the risk of osteoporosis, osteopenia, and broken bones

Which is the purpose of pulmonary function tests when diagnosing asthma?

To evaluate the degree of airway obstruction

The nurse is teaching a young patient with cystic fibrosis (CF) about the importance of maintaining a high-calorie, high-fat diet. Which recommendation should the nurse provide in terms of total daily calorie intake?

Total calories should be 50% more than that of a person without CF.

After obtaining arterial blood gas (ABG) the nurse sent the blood tubes to the lab for evaluation. Which of the following sets of lab results are all within normal limits?

pH: 7.4 PaCO2: 40 PaO2: 85 - Normal adult pH is 7.35-7.45, PaCO2 is 35-45 mmHg, and PaO2 is 75-100

The nurse is teaching a patient with asthma about how to prevent asthma attacks. Which patient statement indicates that further teaching is required?

"I will dust my house weekly."

The nurse is reviewing the pathophysiology of asthma with colleagues. Which statement by the nurse is accurate?

"Inflammatory mediators cause the symptoms of an asthma attack."

What drug class is ipratropium, and what is its mechanism of action?

Anticholinergic drug that causes bronchodilation of airway smooth muscles.

Bariatric surgery is an option for which category of​ clients?

Morbidly obese

The nurse is teaching a patient who is suspected of having allergic asthma about upcoming testing. Which patient statement indicates that the teaching was effective?

"A scratch test will tell me how severe my allergy is."

A patient with cystic fibrosis (CF) asks the nurse why they need to maintain a high-calorie, high-fat diet. Which response by the nurse explains the need for 50% more calories?

"CF affects digestion and nutrient absoption, so you need extra calories."

Mr. Clark received new orders for Levaquin 750 mg once per day for 10 days, and continuous home oxygen @ 2 liters per nasal cannula. You decide to complete client teaching on the new oxygen therapy orders and antibiotic regimen. Which of Mr. Clark's comments indicates the need for further teaching?

"I can stop my oxygen therapy if my nasal passages become too dry, my SpO2 reaches 90%, and the antibiotics begin to improve my respiratory symptoms."

The nurse is admitting a pregnant patient following an acute asthma attack. Which patient statement indicates the need for teaching regarding asthma and medication use?

"I have not been taking my asthma medication because I am pregnant."

During a family-centered patient-teaching session with a patient with cystic fibrosis (CF), the nurse teaches interventions to prevent infection. Which patient statement indicates understanding of the teaching?

"I should cough into a clean tissue and throw it away immediately."

A 5-year-old patient who was diagnosed with asthma is being discharged after a brief hospitalization. The nurse is completing the discharge teaching with the parents. Which parent statement requires further teaching?

"I will always step outside of the house to smoke."

The nurse is teaching a patient with cystic fibrosis who reports increased urinary incontinence. Which response by the patient indicates understanding of the teaching?

"Kegel exercises can help improve my weakened pelvic muscles."

The nurse is assessing a 19-year-old man with cystic fibrosis (CF) who states that they are finding their condition is less controlled with the current combination of pharmacologic and nonpharmacologic therapies. How should the nurse respond?

"Tell me more about how your condition is less controlled."

The family of a patient with cystic fibrosis (CF) is learning how to perform chest percussion therapy (CPT) to promote airway clearance. Which instruction should the nurse include regarding positioning?

"The patient should sit or lie with their head down while CPT is being performed."

A patient's healthcare provider has directed the patient to obtain peak flowmeter readings throughout the day over the next several weeks to establish baseline flow readings. The patient asks why it is necessary to take readings so often. How should the nurse respond?

"The readings will be used to evaluate the severity of future airway obstruction."

The nurse is performing a nutritional assessment of a client who weighs 185 lb and is 5​ feet, 3 inches tall. This​ client's body mass​ index, rounded to the nearest​ hundredth, is:

32.77 BMI

An older adult patient with a history of allergies presents with manifestations of wheezing and difficulty breathing after a stroll in their backyard. Physical assessment findings include tachypnea, use of accessory neck muscles, prolonged expiration, intercostal retractions, decreased breath sounds, and expiratory wheezes. Which condition should the nurse suspect?

An allergic hypersensitivity caused the acute asthma attack

Which manifestation is a hallmark that the nurse should recognize finding in a patient suspected of cystic fibrosis?

An increased amount of chloride in the sweat

A patient with asthma is taking an inhaler that blocks parasympathetic input to bronchial smooth muscles. Which class of medication is this patient taking for asthma control?

Anticholinergic

Which advice should the nurse include when teaching parents of a child with asthma about triggers?

Avoiding secondhand smoke

Which of the following statements best characterizes vitamin​ use?

Clients should be careful not to exceed recommended allowances for daily vitamin intake.

The nurse is assessing an elderly patient suspected of having asthma. Which is one of the most common symptoms of asthma in this age group?

Cough

The nurse is caring for a patient with asthma. Which manifestation noted during patient assessment should the nurse associate with the classification of moderate persistent asthma?

Daily symptoms and exacerbations that can last for days

The nurse is preparing teaching material on the many unique concerns that manifest during the adulthood of a patient with cystic fibrosis (CF). Which condition should the nurse include to be a result of the long-term effect on the body?

Damage to the lungs, pancreas, and liver may lead to organ replacement.

The nurse is caring for a client with chronic constipation. Which findings in the​ client's health history could be the cause of the current​ constipation? Select all that apply.

Depression Low-fiber foods Bedrest Chronic laxative use

You are now preparing to administer ipratropium via mouthpiece. What patient teaching is important for you to provide?

During drug administration, keep lips sealed around mouthpiece. Rinse your mouth after the treatment is complete. Breathe deeply and slowly through your mouth.

Which of Mr. Walsh's symptoms is most important to address first?

Dyspnea

Prioritization of care is primary to the concept of clinical reasoning. Which client symptoms reveal they should be triaged for immediate care and follow up with the physician?

James Clark, 58 years old, with COPD, on 2 L O2 PRN @ HS, presents with complaints of increased SOB and productive cough of greenish-brown sputum. SpO2 86% on room air, T 100.9°F, R 26.

The nurse is providing discharge teaching to an asthmatic patient. Which lifestyle alterations should the nurse suggest to improve asthma management?

Maintaining a healthy weight

A patient with asthma is having difficulty breathing while lying supine. The patient can talk in phrases without experiencing shortness of breath and has a moderately elevated respiratory rate. Which level of an asthma attack did the patient have based on these assessment findings?

Mild

Why would the provider have chosen to prescribe an anticholinergic drug for Mr. Walsh rather than a short-acting beta adrenergic agonist?

Mr. Walsh was already taking a short-acting beta adrenergic agonist without success.

The nurse is assessing a 5-year-old boy with cystic fibrosis. The patient's parent is confused about the medication and asks, "Which one of these medications breaks up his secretions?" Which response by the nurse is accurate?

Mucolytic

The nurse is providing care to a client who is experiencing constipation. The healthcare provider prescribes​ Metamucil, a​ bulk-forming laxative. Which is a nursing consideration when administering this medication to the​ client?

Offering sufficient water

The nurse is teaching an 8-year-old patient with asthma how to use an inhaler with a spacer. Which information should the nurse include?

Place the mouthpiece of the spacer in your mouth and form a tight seal with the lips.

The nurse is caring for a patient experiencing an asthma attack. Which nursing intervention is most appropriate to address the patient's shortness of breath?

Placing the patient in a high Fowler position

The nurse is assessing a 24-year old woman with cystic fibrosis (CF) who would like to start a family. The patient and the spouse want to discuss what to expect with the pregnancy and birth of their child. Which topic related to a mother with CF should the nurse include?

Possible decreased fertility

While Mr. Brown is waiting to be evaluated by the physician, the nurse decides to reinforce teaching on health promotion and management of respiratory symptoms. What should the teaching emphasize?

Practice good oral hygiene and brush/floss teeth regularly. Inform the healthcare provider of details regarding work-related travel. Cover the mouth or nose when exposed to cold temperatures. Perform diaphragmatic breathing/coughing exercises and improve exercise tolerance.

The parent of a child newly diagnosed with cystic fibrosis (CF) asks, "What is the best way to help my child eliminate mucus?" Which recommendation by the nurse is appropriate?

Practicing huffing

The nurse is evaluating the oxygenation status of a patient during an asthma attack. Which diagnostic tool would be the most useful for gathering this information?

Pulse oximeter

The nurse is preparing to teach a class on the prevention of constipation. Which food choice will the nurse include as an example of a​ high-fiber food?

Raw fruits

To assess the level of severity of Sally's asthma, it is important to obtain the following: *PaCO2: Measures the partial pressure of carbon dioxide (PaCO2) and adequacy of alveolar ventilation. Alveolar damage causes hypoventilation and carbon dioxide (CO2) cannot release. *pH: Determines the acidity or alkaline condition of body fluids. *PaO2: Measures the amount of oxygen available to bind with hemoglobin. The nurse understands the best way to assess these basic values and Sally's acid-base balance is to:

Take an arterial blood gas specimen.

The nurse is assessing the nutritional status of an older client. Which finding is most likely to suggest​ xerostomia?

The client has a chronically dry mouth despite adequate intake of fluids.

The nurse is planning care for a patient who is diagnosed with asthma. Which expected outcome is appropriate for this patient?

The patient will verbalize triggers for asthma attacks.

The nurse is performing an assessment for a patient with a history of asthma. Which finding indicates that the asthma is worsening and requires the nurse to take immediate action?

Use of accessory muscles in breathing

A client in the ambulatory care clinic tells the nurse about experiencing frequent constipation. The nurse inquires about the​ client's diet. Which statement from the client would be of greatest concern for the​ nurse?

"I like to eat cheese, bananas, and a turkey sandwich for lunch."

The nurse is reviewing discharge instructions with the mother of a toddler who was hospitalized for constipation. Which statement made by the​ toddler's mother indicates the need for further​ education?

"I need to make sure my child eats a​ low-fiber diet."

After the physician's examination, Mrs. Becerra received the following new orders: PRN oxygen therapy at HS, increase Lasix dose to 40 mg every morning, and obtain/record daily weights - schedule a follow-up visit with physician in 2 weeks. After medication and disease management teaching, the nurse recognizes the need for further instruction when the client states:

"I need to use my oxygen if my SpO2 ≤88% and I can independently cut my Lasix dose back to my previous prescription whenever I feel that my leg and ankle swelling has resolved."

The nurse is providing care to a client who ignores the urge to defecate when at work. The client​ states, "I​ don't like to have a bowel movement anywhere but at​ home." Which response by the nurse is the most​ appropriate?

"If you continue to ignore the urge to​ defecate, it can lead to​ problems."

The nurse is explaining the risk factors for cystic fibrosis (CF) to a couple planning to have a family. The husband informs the nurse of having a relative who has cystic fibrosis (CF) and asks "Does that mean my child will have CF?" Which response from the nurse is accurate?

"To have cystic fibrosis, a child must inherit one copy of the cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation from each parent."

The nurse provides education and supportive assistance for the family of a​ preschool-age client diagnosed with encopresis. Which statement indicates parental understanding of appropriate​ care? Select all that apply.

"We will establish a limited schedule of activities that has many breaks to provide opportunities to use the toilet​ regularly." "We will work on regular elimination after morning and evening​ meals." "We will schedule an appointment with a play therapist to help our older child adjust to our new​ baby."

The nurse is caring for a child recently diagnosed with cystic fibrosis (CF). The mother is trying to cope with the diagnosis and asks the nurse, "What caused this?" Which response by the nurse is accurate?

"You didn't do anything wrong. CF is caused by an inherited gene mutation that causes a problem with the balance of salt and water in the mucous cells."

Along with obtaining vital signs, what nursing interventions and actions should be initiated specific to the varied needs of each client?

- Auscultate lung sounds and assess chest wall for shape and symmetry during inspiration/expiration. - Interview clients to gather subjective data and pace the dialogue so that clients can answer questions at their own speed. For example: When does the cough start? Are you currently taking any medications? Are there times when breathing is more difficult? - Aid clients with proper positioning while sitting or lying down. - Prepare suction equipment and oxygen in case clients develop respiratory distress.

The nurse is preparing a presentation to colleagues on cystic fibrosis (CF) and plans to include the role of the cystic fibrosis transmembrane conductance regulator (CFTR) protein in the body. Which information should the nurse include?

CFTR is responsible for regulating the movement of chloride across cellular membranes.

The nurse is teaching the mother of a child who has recently been diagnosed with asthma. The nurse should explain that which type of asthma attack is triggered by the loss of heat or moisture from the bronchial surface?

Exercise-induced

The provider has ordered you to administer methylprednisolone (Solu-Medrol) via IV injection. Which dosing instructions would prompt you to double check the instructions with the provider?

Administer 0.5 g methylprednisolone in 2 mL isotonic saline solution by IV injection.

The nurse is completing a focused physical examination of a patient with asthma. Which assessments should be included for this exam?

Auscultation of the lungs and assessment of level of consciousness

A nurse is caring for four clients with renal calculi. Of these​ clients, which one should the nurse identify as having the highest likelihood of requiring surgery to remove the​ calculi?

A​ 78-year-old client with struvite stones of the kidney

A young pregnant patient who is visiting the clinic with her spouse informs the nurse that they both carry the gene for cystic fibrosis (CF). Which diagnostic test should the nurse expect the healthcare provider to order to determine the health of the fetus?

Chorionic villus sampling (CVS)

During a home​ visit, the nurse is assessing an older adult client. Which assessment findings support the nursing diagnosis Imbalanced​ Nutrition: Less than Body​ Requirements? Select all that apply.

Client is prescribed 15 medications. Client reports a problem with dentures slipping while chewing. Client's Social Security payments have gone down over the last year. Client complains of occasional dry mouth and problems with feelings of nausea.

To aide in diagnoses of Mr. Brown's respiratory illness, the physician orders a common test that will differentiate pathologic conditions (tumors, abscesses) and reveal pleural effusion and enlarged lymph nodes in the pleura and mediastinum. The nurse understands this test may involve use of contrast dye, and that it requires obtaining information from the client regarding iodine allergies, including the client's use of shellfish, oral antidiabetic medications such as metformin (Glucophage), or any over-the-counter medication such as non-steroidal anti-inflammatory (NSAIDs) drugs. Fluid intake is restricted 4 hours prior to the test. The physician wrote an order for the following test:

Computerized Tomography (CT) scans of the thorax

After 15 minutes of treatment with the nebulizer, you re-assess Mr. Walsh's vital signs as well as his lung functions tests, which have the following results: FEV1: 2.0 L (predicted 4.1 L; 48.8%) FVC: 3.9 L (predicted 5.2 L; 75.0%) PEF: 238 L/min (predicted 643 L/min; 37.0%) FEV1/FVC: 51.3% SpO2: 86% What steps should you take next?

Consult with the provider about other medications to administer Increase oxygen flow to 6L/min

The community health nurse reviews data collected during interviews with community members during a health fair and decides to create a brochure on how to improve iron intake. Which of the following action items might the nurse include that would help vegans and vegetarians increase their iron​ intake? Select all that apply.

Consume lentils. Consume Swiss chard. Increase intake of vitamin C. Consume tofu.

During a health​ assessment, a client​ states, "I only eat carbohydrates and​ low-fat foods. I​ don't understand why I am still gaining​ weight!" Which principles of nutrition should guide the​ nurse's response? Select all that apply.

Eating too many carbohydrates leads to excess​ glucose, which is converted to fat. Carbohydrates should be high in fiber and low in sugar. Excess carbohydrates can lead to obesity.

The nurse is assessing a patient with cystic fibrosis (CF). Which assessment activity is the priority?

Inspect the patient for retractions and nasal flaring.

The nurse is assessing a teenage boy with cystic fibrosis. The parent of the patient states that the boy has been feeling down and tired all the time, playing video games most of the day. Which recommendation should the nurse provide to improve overall health and endurance of this patient?

Increase physical activity.

A new staff nurse is developing a plan of care for a patient with asthma. Which nursing intervention in the plan of care indicates the need for the preceptor nurse to intervene?

Increasing external stimuli

A patient with asthma is prescribed an anticholinergic agent. Which rationale describes using this type of medication?

It blocks parasympathetic input to bronchial smooth muscles.

The nurse is assessing a client who has recently had several blood tests done. Which laboratory results would the nurse identify as indicators of​ malnutrition? Select all that apply.

PAB 100​ mg/L PAB 12​ mg/dL Cholesterol 120​ mg/dL

Fecal impaction is a mass or collection of hardened feces in the folds of the rectum or colon as a result of prolonged retention and accumulation of fecal material. Which clinical manifestation is common in cases of fecal​ impaction?

Passage of​ liquid, foul-smelling fecal material in the absence of formed stool

The nurse is caring for a client who is experiencing intermittent constipation. The client has been advised to increase the amount of dietary fiber. Which food selections by the client indicate that teaching has been​ effective? Select all that apply.

Peas Spinach salad Carrot slices

The nurse is teaching a young woman recently diagnosed with cystic fibrosis and their parent about chest physical therapy (CPT) and postural drainage. Which instruction should the nurse include?

Percuss or vibrate only over the upper ribs and never over the sternum, breastbone, stomach, or lower ribs and back.

The nurse is teaching a patient who is newly diagnosed with asthma about possible asthma triggers. Which triggers should the nurse instruct the patient to avoid?

Pets, smoke, stuffed animals

You confirm with the provider that you should immediately administer 125 mg methylprednisolone in 2 mL isotonic saline solution. You are preparing to insert the IV for the injection. Which is the best choice for the IV for Mr. Walsh?

Place a 22-gauge needle in the cephalic vein of his non-dominant arm

While auscultating Mr. Clark's lung sounds, you hear musical, relatively low-pitched snoring sounds that are continuous and predominately heard on expiration. You document these assessment findings as:

Rhonchi

The nurse is planning care for a newly admitted bedbound older adult client. Which nursing diagnosis would be most appropriate for this​ client?

Risk for Constipation

Thirty minutes after methylprednisolone administration, you again check Mr. Walsh's pulmonary function tests. The results are: FEV1: 2.9 L (predicted 4.1 L; 70.7%) FVC: 4.5 L (predicted 5.2 L; 86.5%) PEF: 427 L/min (predicted 643 L/min; 66.4%) FEV1/FVC: 64.4% SpO2: 92% Although Mr. Walsh still has reduced pulmonary function, his breathing is less labored. The provider plans to admit Mr. Walsh for observation and continued medication administration. He also plans to add salmeterol + fluticasone (Advair Diskus 250/50) to Mr. Walsh's maintenance drug regimen at a dose of 1 puff twice daily. What risk diagnosis is appropriate for Mr. Walsh based on his new medication regimen?

Risk for Infection

What patient teaching will you provide Mr. Walsh about salmeterol + fluticasone? Select all that apply.

Salmeterol + fluticasone should not be used as a rescue inhaler. Salmterol + fluticasone may mask the symptoms of an infection.

The nurse suspects Mrs. Becerra's oxygenation impairments are related to CHF exacerbation. The nurse's assessments of breath sounds, including heart and respiration rates, are essential for obtaining objective data concerning the cardiopulmonary system. Identify the correct assessment technique, including respiration and heart rates, that are within normal limits.

Using the diaphragm of a stethoscope, have the patient sit upright, and auscultate the lungs in a systematic left-to-right sequence by having the client take slow, deep breaths through her mouth. Listen over the anterior, posterior, and lateral intercostal spaces. The nurse counts respirations at 18 and a heart rate of 90.

The nurse is preparing to discharge a client with diarrhea. The healthcare provider prescribes loperamide to manage the​ client's diarrhea. After providing the client with information on this​ medication, which client statement indicates the need for further​ education?

​"I should continue to take this medication daily until my stools are firm and​ dry."