Pulmonary

A 55-year-old patient with increasing dyspnea is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD). When teaching a patient about pulmonary function testing (PFT) for this condition, what is the most important question the nurse should ask? "Have you taken any bronchodilators in the past 6 hours?" "Are you claustrophobic?" "Are you allergic to shellfish?" "Do you have any metal implants or prostheses?"

"Have you taken any bronchodilators in the past 6 hours?"

The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with obstructive pulmonary disease. Which patient will require the most rapid action by the nurse? 65-year-old with ABG results: pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg 22-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg 34-year-old with ABG results: pH 7.48, PaCO2 30 mm Hg, and PaO2 65 mm Hg 45-year-old with ABG results: pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg

22-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg

A patient is concerned that he may have asthma. Of the symptoms that he relates to the nurse, which ones suggest asthma or risk factors for asthma (select all that apply)? a. Allergic rhinitis b. Prolonged inhalation c. History of skin allergies d. Cough, especially at night e. Gastric reflux or heartburn

A, C, D, E

The effects of cigarette smoking on the respiratory system include a. hypertrophy of capillaries causing hemoptysis. b. hyperplasia of goblet cells and increased production of mucus. c. increased proliferation of cilia and decreased clearance of mucus. d. proliferation of alveolar macrophages to decrease the risk for infection.

B

The nurse teaches a patient about the transmission of pulmonary tuberculosis (TB). Which statement, if made by the patient, indicates that teaching was effective? "I will take the bus instead of driving to visit my friends." "I will keep the windows closed at home to contain the germs." "My husband will be sleeping in the guest bedroom." "I will avoid being outdoors whenever possible."

"My husband will be sleeping in the guest bedroom."

Which assessment finding in a patient who has received omalizumab (Xolair) is most important to report immediately to the health care provider? Flushing and dizziness Respiratory rate 22 breaths/minute Peak flow reading 75% of normal Pain at injection sit

Flushing and dizziness

The clinic nurse makes a follow-up telephone call to a patient with asthma. The patient reports having a baseline peak flow reading of 600 L/minute and the current peak flow is 420 L/minute. Which action should the nurse take first? Ask about recent exposure to any new allergens or asthma triggers. Question the patient about use of the prescribed inhaled corticosteroids. Tell the patient to go to the hospital emergency department. Instruct the patient to use the prescribed albuterol (Proventil).

Instruct the patient to use the prescribed albuterol (Proventil).

The nurse teaches a patient about pursed lip breathing. Which action by the patient would indicate to the nurse that further teaching is needed? The patient practices by blowing through a straw. The patient inhales slowly through the nose. The patient puffs up the cheeks while exhaling. The patient's ratio of inhalation to exhalation is 1:3.

The patient puffs up the cheeks while exhaling.

Which instruction should the nurse include in an exercise teaching plan for a patient with chronic obstructive pulmonary disease (COPD)? "Upper body exercise should be avoided to prevent dyspnea." "Stop exercising if you start to feel short of breath." "Breathe in and out through the mouth while you exercise." "Use the bronchodilator before you start to exercise."

"Use the bronchodilator before you start to exercise."

For which patients with pneumonia would the nurse suspect aspiration as the likely cause of pneumonia (select all that apply)? a. Patient with seizures b. Patient with head injury c. Patient who had thoracic surgery d. Patient who had a myocardial infarction e. Patient who is receiving nasogastric tube feeding

A, B, E

A patient who is experiencing an acute asthma attack is admitted to the emergency department. Which assessment should the nurse complete first? Determine when the dyspnea started. Listen to the patient's breath sounds. Obtain the forced expiratory volume (FEV) flow rate. Ask about inhaled corticosteroid use.

Listen to the patient's breath sounds.

Which finding by the nurse for a patient with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment? Absence of wheezes, rhonchi, or crackles Respiratory rate of 18 breaths/minute Even, unlabored respirations Pulse oximetry reading of 92%

Pulse oximetry reading of 92%

After change-of-shift report, which patient should the nurse assess first? 28-year-old with a history of a lung transplant and a temperature of 101° F (38.3° C) 72-year-old with cor pulmonale who has 4+ bilateral edema in his legs and feet 40-year-old with a pleural effusion who is complaining of severe stabbing chest pain 64-year-old with lung cancer and tracheal deviation after subclavian catheter insertion

64-year-old with lung cancer and tracheal deviation after subclavian catheter insertion

Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis? A. Weak, nonproductive cough effort B. Large amounts of greenish sputum C. Respiratory rate of 28 breaths/minute D. Resting pulse oximetry (SpO2) of 85%

A

In evaluating an asthmatic patient's knowledge of self-care, the nurse recognizes that additional instruction is needed when the patient says, a. "I use my corticosteroid inhaler when I feel short of breath." b. "I get a flu shot every year and see my health care provider if I have an upper respiratory tract infection." c. "I use my inhaler before I visit my aunt who has a cat, but I only visit for a few minutes because of my allergies." d. "I walk 30 minutes every day but sometimes I have to use my bronchodilator inhaler before walking to prevent me from getting short of breath."

A

The nurse is preparing the patient for a diagnostic procedure to remove pleural fluid for analysis. The nurse would prepare the patient for which test? a. Thoracentesis b. Bronchoscopy c. Pulmonary angiography d. Sputum culture and sensitivity

A

To promote the release of surfactant, the nurse encourages the patient to a. take deep breaths. b. cough five times per hour to prevent alveolar collapse. c. decrease fluid intake to reduce fluid accumulation in the alveoli. d. sit with head of bed elevated to promote air movement through the pores of Kohn

A

When assessing activity-exercise patterns related to respiratory health, the nurse inquires about a. dyspnea during rest or exercise. b. recent weight loss or weight gain. c. ability to sleep through the entire night. d. willingness to wear oxygen equipment in public.

A

When teaching a patient about the most important respiratory defense mechanism distal to the respiratory bronchioles, which topic would the nurse discuss? a. Alveolar macrophages b. Impaction of particles c. Reflex bronchoconstriction d. Mucociliary clearance mechanism

A

The nurse receives change-of-shift report on the following four patients. Which patient should the nurse assess first? A 23-year-old patient with cystic fibrosis who has pulmonary function testing scheduled A 35-year-old patient who was admitted the previous day with pneumonia and has a temperature of 100.2° F (37.8° C) A 77-year-old patient with tuberculosis (TB) who has four antitubercular medications due in 15 minutes A 46-year-old patient on bed rest who is complaining of sudden onset of shortness of breath

A 46-year-old patient on bed rest who is complaining of sudden onset of shortness of breath

The nurse receives a change-of-shift report on the following patients with chronic obstructive pulmonary disease (COPD). Which patient should the nurse assess first? A patient with a respiratory rate of 38/minute A patient with jugular venous distention and peripheral edema A patient who has a cough productive of thick, green mucus A patient with loud expiratory wheezes

A patient with a respiratory rate of 38/minute

A student nurse asks the RN what can be measured by arterial blood gases (ABGs). The RN tells the student that the ABGs can measure (select all that apply) a. acid-base balance. b. oxygenation status. c. acidity of the blood. d. glucose bound to hemoglobin. e. bicarbonate (HCO3−) in arterial blood.

A, B, C, E

A patient seen in the asthma clinic has recorded daily peak flows that are 75% of the baseline. Which action will the nurse plan to take next? Instruct the patient to keep the next scheduled follow-up appointment. Increase the dose of the leukotriene inhibitor. Teach the patient about the use of oral corticosteroids. Administer a bronchodilator and recheck the peak flow.

Administer a bronchodilator and recheck the peak flow.

An alcoholic and homeless patient is diagnosed with active tuberculosis (TB). Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen? Arrange for a friend to administer the medication on schedule. Teach the patient about the high risk for infecting others unless treatment is followed. Arrange for a daily noon meal at a community center where the drug will be administered. Give the patient written instructions about how to take the medications.

Arrange for a daily noon meal at a community center where the drug will be administered.

Which finding in a patient hospitalized with bronchiectasis is most important to report to the health care provider? Scattered rhonchi and wheezes heard bilaterally Complaint of sharp chest pain with deep breathing Respiratory rate 28 breaths/minute while ambulating in hallway Cough productive of bloody, purulent mucus

Cough productive of bloody, purulent mucus

A patient is admitted with active tuberculosis (TB). The nurse should question a health care provider's order to discontinue airborne precautions unless which assessment finding is documented? A. Chest x-ray shows no upper lobe infiltrates. B. TB medications have been taken for 6 months. C. Mantoux testing shows an induration of 10 mm. D. Three sputum smears for acid-fast bacilli are negative.

D

Which guideline would be a part of teaching patients how to use a metered-dose inhaler (MDI)? a. After activating the MDI, breathe in as quickly as you can. b. Estimate the amount of remaining medicine in the MDI by floating the canister in water. c. Disassemble the plastic canister from the inhaler and rinse both pieces under running water every week. d. To determine how long the canister will last, divide the total number of puffs in the canister by the puffs needed per day

D

A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. The nurse finds a heart rate of 142 beats/minute, blood pressure of 100/60 mmHg, and respirations of 42 breaths/minute. Which action should the nurse take first? Prepare patient for a spiral computed tomography (CT). Administer anticoagulant drug therapy. Notify the patient's health care provider. Elevate the head of the bed to a semi-Fowler's position.

Elevate the head of the bed to a semi-Fowler's position.

A patient with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would be most appropriate? Ask the patient to rest in bed in a high-Fowler's position with the knees flexed. Encourage the patient to sit up at the bedside in a chair and lean slightly forward. Have the patient rest in bed with the head elevated to 15 to 20 degrees. Place the patient in the Trendelenburg position with several pillows behind the head.

Encourage the patient to sit up at the bedside in a chair and lean slightly forward.

A patient who is taking rifampin (Rifadin) for tuberculosis calls the clinic and reports having orange discolored urine and tears. Which is the best response by the nurse? Ask the patient about any visual abnormalities such as red-green color discrimination. Explain that orange discolored urine and tears are normal while taking this medication. Advise the patient to stop the drug and report the symptoms to the health care provider. Ask if the patient is experiencing shortness of breath, hives, or itching.

Explain that orange discolored urine and tears are normal while taking this medication.

A patient with pneumonia has a fever of 101.4° F (38.6° C), a nonproductive cough, and an oxygen saturation of 88%. The patient complains of weakness, fatigue, and needs assistance to get out of bed. Which nursing diagnosis should the nurse assign as the highest priority? Impaired transfer ability related to weakness Impaired gas exchange related to respiratory congestion Ineffective airway clearance related to thick secretions Hyperthermia related to infectious illness

Impaired gas exchange related to respiratory congestion

The nurse is admitting a patient diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD).What is the best way for the nurse to determine the appropriate oxygen flow rate? Avoid administration of oxygen at a rate of more than 2 L/minute Maintain the pulse oximetry level at 90% or greater. Minimize oxygen use to avoid oxygen dependency. Administer oxygen according to the patient's level of dyspnea.

Maintain the pulse oximetry level at 90% or greater.

The nurse notes that a patient has incisional pain, a poor cough effort, and scattered rhonchi after a thoracotomy. Which action should the nurse take first? Observe the patient use the incentive spirometer. Medicate the patient with prescribed morphine. Assist the patient to sit upright in a chair. Splint the patient's chest during coughing.

Medicate the patient with prescribed morphine.

A patient who is experiencing an asthma attack develops bradycardia and a decrease in wheezing. Which action should the nurse take first? Notify the health care provider. Document changes in respiratory status. Administer IV methylprednisolone (Solu-Medrol). Encourage the patient to cough and deep breathe.

Notify the health care provider.

The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment would best evaluate the effectiveness of the therapies? Palpate for heaves or thrills over the heart. Auscultate for crackles in the lungs. Observe for distended neck veins. Review hemoglobin and hematocrit values.

Observe for distended neck veins.

Which nursing action for a patient with chronic obstructive pulmonary disease (COPD) could the nurse delegate to experienced unlicensed assistive personnel (UAP)? Adjust oxygen to keep saturation in prescribed parameters. Obtain oxygen saturation using pulse oximetry. Teach the patient about safe use of oxygen at home. Monitor for increased oxygen need with exercise.

Obtain oxygen saturation using pulse oximetry.

A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which intervention would be most appropriate for the nurse to include in the plan of care? Offer high-calorie snacks between meals and at bedtime. Increase the patient's intake of fruits and fruit juices. Encourage increased intake of whole grains. Assist the patient in choosing foods with high vegetable and mineral content.

Offer high-calorie snacks between meals and at bedtime.

The nurse cares for a patient who has just had a thoracentesis. Which assessment information obtained by the nurse is a priority to communicate to the health care provider? Blood pressure is 145/90 mm Hg. Respiratory rate is 22 breaths/minute when lying flat. Oxygen saturation is 88%. Pain level is 5 (on 0 to 10 scale) with a deep breath.

Oxygen saturation is 88%.

The emergency department nurse is evaluating the effectiveness of therapy for a patient who has received treatment during an asthma attack. Which assessment finding is the best indicator that the therapy has been effective? Respiratory rate is 16 breaths/minute. Oxygen saturation is >90%. Accessory muscle use has decreased. No wheezes are audible.

Oxygen saturation is >90%.

A patient with idiopathic pulmonary arterial hypertension (IPAH) is receiving nifedipine (Procardia). Which assessment would best indicate to the nurse that the patient's condition is improving? Patient's chest x-ray indicates clear lung fields. Patient reports decreased exertional dyspnea. Blood pressure (BP) is less than 140/90 mm Hg. Heart rate is between 60 and 100 beats/minute.

Patient reports decreased exertional dyspnea.

A young adult patient with cystic fibrosis (CF) is admitted to the hospital with increased dyspnea. Which intervention should the nurse include in the plan of care? Arrange for a hospice nurse visit. Perform chest physiotherapy every 4 hours. Place the patient on a low-sodium diet. Schedule a sweat chloride test.

Perform chest physiotherapy every 4 hours.

The nurse is caring for a patient with cor pulmonale. The nurse should monitor the patient for which expected finding? Complaints of chest pain Elevated temperature Peripheral edema Clubbing of the fingers

Peripheral edema

The nurse develops a plan of care to prevent aspiration in a high-risk patient. Which nursing action will be most effective? Insert nasogastric tube for feedings for patients with swallowing problems. Turn and reposition immobile patients at least every 2 hours. Place patients with altered consciousness in side-lying positions. Monitor for respiratory symptoms in patients who are immunosuppressed.

Place patients with altered consciousness in side-lying positions.

A patient with a pleural effusion is scheduled for a thoracentesis. Which action should the nurse take to prepare the patient for the procedure? Remove the water pitcher and remind the patient not to eat or drink anything for 6 hours. Start a peripheral IV line to administer the necessary sedative drugs. Obtain a large collection device to hold 2 to 3 liters of pleural fluid at one time. Position the patient sitting upright on the edge of the bed and leaning forward.

Position the patient sitting upright on the edge of the bed and leaning forward.

A patient newly diagnosed with asthma is being discharged. The nurse anticipates including which topic in the discharge teaching? Self-administration of inhaled corticosteroids Side effects of sustained-release theophylline Use of long-acting b-adrenergic medications Complications associated wit oxygen therapy

Self-administration of inhaled corticosteroids

A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of impaired breathing pattern related to anxiety. Which nursing action is most appropriate to include in the plan of care? Titrate oxygen to keep saturation at least 90%. Teach the patient how to effectively use pursed lip breathing. Suggest the use of over-the-counter sedative medications. Discuss a high-protein, high-calorie diet with the patient.

Teach the patient how to effectively use pursed lip breathing.

The nurse educator is evaluating the care that a new registered nurse (RN) provides to a patient receiving mechanical ventilation. Which action by the new RN indicates the need for more education? The RN increases the FIO2 to 100% before suctioning. The RN positions the patient with the head of bed at 10 degrees. The RN secures a bite block in place using adhesive tape. The RN asks for assistance to reposition the endotracheal tube.

The RN positions the patient with the head of bed at 10 degrees.

The nurse educator is evaluating the performance of a new registered nurse (RN) who is providing care to a patient who is receiving mechanical ventilation with 15 cm H2O of peak end-expiratory pressure (PEEP). Which action indicates that the new RN is safe? The RN changes the ventilator circuit tubing routinely every 48 hours. The RN tapes connection between the ventilator tubing and the ET. The RN plans to suction the patient every 1 to 2 hours. The RN uses a closed-suction technique to suction the patient.

The RN uses a closed-suction technique to suction the patient.

The nurse interviews a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which information is most helpful in confirming a diagnosis of chronic bronchitis? The patient's history indicates a 30 pack-year cigarette history. The patient denies having any respiratory problems until the last 12 months. The patient tells the nurse about a family history of bronchitis. The patient complains about a productive cough every winter for 3 months.

The patient complains about a productive cough every winter for 3 months.

The nurse teaches a patient with chronic bronchitis about a new prescription for Advair Diskus (combined fluticasone and salmeterol). Which action by the patient would indicate to the nurse that teaching about medication administration has been successful? The patient shakes the device before use. The patient attaches a spacer to the Diskus. The patient performs huff coughing after inhalation. The patient rapidly inhales the medication.

The patient rapidly inhales the medication.

The nurse teaches a patient how to administer formoterol (Perforomist) through a nebulizer. Which action by the patient indicates good understanding of the teaching? The patient coughs vigorously after using the inhaler. The patient attaches a spacer before using the inhaler. The patient activates the inhaler at the onset of expiration. The patient removes the facial mask when misting has ceased.

The patient removes the facial mask when misting has ceased.

The nurse takes an admission history on a patient with possible asthma who has new-onset wheezing and shortness of breath. Which information may indicate a need for a change in therapy? The patient takes propranolol (Inderal) for hypertension. The patient has a history of pneumonia 6 months ago. The patient uses acetaminophen (Tylenol) for headaches. The patient has chronic inflammatory bowel disease.

The patient takes propranolol (Inderal) for hypertension.

The nurse teaches a patient who has asthma about peak flow meter use. Which action by the patient indicates that teaching was successful? The patient takes montelukast (Singulair) for peak flows in the red zone. The patient uses albuterol (Proventil) metered dose inhaler (MDI) for peak flows in the yellow zone. The patient inhales rapidly through the peak flow meter mouthpiece. The patient calls the health care provider when the peak flow is in the green zone.

The patient uses albuterol (Proventil) metered dose inhaler (MDI) for peak flows in the yellow zone.

The nurse completes an admission assessment on a patient with asthma. Which information given by patient is most indicative of a need for a change in therapy? The patient's heart rate increases after using the albuterol (Proventil) inhaler. The patient uses albuterol (Proventil) before any aerobic exercise. The patient's only medications are albuterol (Proventil) and salmeterol (Serevent). The patient says that the asthma symptoms are worse every spring.

The patient's only medications are albuterol (Proventil) and salmeterol (Serevent).

Which assessment finding obtained by the nurse when caring for a patient receiving mechanical ventilation indicates the need for suctioning? The patient's oxygen saturation is 93%. The patient's respiratory rate is 32 breaths/minute. The patient was last suctioned 6 hours ago. The patient has occasional audible expiratory wheezes.

The patient's respiratory rate is 32 breaths/minute.

A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days. Which assessment data obtained by the nurse indicates that the treatment has been effective? Selected Answer: The patient coughs up small amounts of green mucus. The patient's white blood cell (WBC) count is 9000/µL. Bronchial breath sounds are heard at the right base. Increased tactile fremitus is palpable over the right chest.

The patient's white blood cell (WBC) count is 9000/µL.

Which information will the nurse include in the asthma teaching plan for a patient being discharged? Hold your breath for 5 seconds after using the bronchodilator inhaler. Inhale slowly and deeply when using the dry powder inhaler (DPI). Use the inhaled corticosteroid when shortness of breath occurs. Tremors are an expected side effect of rapidly acting bronchodilator

Tremors are an expected side effect of rapidly acting bronchodilator

Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB. Which information should the occupational health nurse plan to teach the staff nurse? Need for annual repeat TB skin testing Use and side effects of isoniazid (INH) Bacille Calmette-Guérin (BCG) vaccine Standard four-drug therapy for TB

Use and side effects of isoniazid (INH)

The nurse assesses a patient with a history of asthma. Which assessment finding indicates that the nurse should take immediate action? Use of accessory muscles in breathing Pulse oximetry reading of 91% Peak expiratory flow rate of 240 L/minute Respiratory rate of 26 breaths/minute

Use of accessory muscles in breathing

Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis? Respiratory rate of 28 breaths/minute Resting pulse oximetry (SpO2) of 85% Weak, nonproductive cough effort Large amounts of greenish sputum

Weak, nonproductive cough effort

A patient is scheduled for pulmonary function testing. Which action should the nurse take to prepare the patient for this procedure? Administer oral corticosteroids 2 hours before the procedure. Give the rescue medication immediately before testing. Withhold bronchodilators for 6 to 12 hours before the examination. Ensure that the patient has been NPO for several hours before the test.

Withhold bronchodilators for 6 to 12 hours before the examination.

The nurse provides dietary teaching for a patient with chronic obstructive pulmonary disease (COPD) who has a low body mass index (BMI). Which patient statement indicates that the teaching has been effective? "I can have ice cream as a snack every day." "I will drink lots of fluids with my meals." "I will decrease my intake of meat and poultry." "I will exercise for 15 minutes before meals."

"I can have ice cream as a snack every day."

A patient has been receiving high-dose corticosteroids and broad- spectrum antibiotics for treatment secondary to a traumatic injury and infection. The nurse plans care for the patient knowing that the patient is most susceptible to a. candidiasis. b. aspergillosis. c. histoplasmosis. d. coccidioidomycosis.

A

A plan of care for the patient with COPD could include (select all that apply) a. exercise such as walking. b. high flow rate of O2 administration. c. low-dose chronic oral corticosteroid therapy. d. use of peak flow meter to monitor the progression of COPD. e. breathing exercises such as pursed-lip breathing that focus on exhalation.

A, E

To detect early signs or symptoms of inadequate oxygenation, the nurse would examine the patient for a. dyspnea and hypotension. b. apprehension and restlessness. c. cyanosis and cool, clammy skin. d. increased urine output and diaphoresis.

B

When auscultating the chest of an older patient in respiratory distress, it is best to a. begin listening at the apices. b. begin listening at the lung bases. c. begin listening on the anterior chest. d. ask the patient to breathe through the nose with the mouth closed.

B

A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of impaired breathing pattern related to anxiety. Which nursing action is most appropriate to include in the plan of care? A. Titrate oxygen to keep saturation at least 90%. B. Discuss a high-protein, high-calorie diet with the patient. C. Suggest the use of over-the-counter sedative medications. D. Teach the patient how to effectively use pursed lip breathing.

D

ANY patient with a respiratory condition asks "How does air get into my lungs?" The nurse bases her answer on her knowledge that air moves into the lungs because of a. contraction of the accessory abdominal muscles. b. increased carbon dioxide and decreased oxygen in the blood. c. stimulation of the respiratory muscles by the chemoreceptors. d. decrease in intrathoracic pressure relative to pressure at the airway

D

While family members are visiting, a patient has a respiratory arrest and is being resuscitated. Which action by the nurse is best? Tell the family members that watching the resuscitation will be very stressful. Take the family members quickly out of the patient room and remain with them. Ask family members if they wish to remain in the room during the resuscitation. Assign a staff member to wait with family members just outside the patient room.

Ask family members if they wish to remain in the room during the resuscitation.

After 2 months of tuberculosis (TB) treatment with isoniazid (INH), rifampin (Rifadin), pyrazinamide (PZA), and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next? Schedule the patient for directly observed therapy three times weekly. Teach about treatment for drug-resistant TB treatment. Ask the patient whether medications have been taken as directed. Discuss with the health care provider the need for the patient to use an injectable antibiotic.

Ask the patient whether medications have been taken as directed.

A patient with bacterial pneumonia has rhonchi and thick sputum. What is the nurse's most appropriate action to promote airway clearance? Instruct the patient on the pursed lip breathing technique. Assist the patient to splint the chest when coughing. Teach the patient about the need for fluid restrictions. Encourage the patient to wear the nasal oxygen cannula.

Assist the patient to splint the chest when coughing.

The nurse notes thick, white secretions in the endotracheal tube (ET) of a patient who is receiving mechanical ventilation. Which intervention will be most effective in addressing this problem? Increase suctioning to every hour. Instill 5 mL of sterile saline into the ET before suctioning. Reposition the patient every 1 to 2 hours. . Add additional water to the patient's enteral feedings.

Add additional water to the patient's enteral feedings.

The nurse reviews the medication administration record (MAR) for a patient having an acute asthma attack. Which medication should the nurse administer first? Salmeterol (Serevent) 50 mcg per dry-powder inhaler (DPI) Methylprednisolone (Solu-Medrol) 60 mg IV Albuterol (Ventolin) 2.5 mg per nebulizer Triamcinolone (Azmacort) 2 puffs per metered-dose inhaler (MDI)

Albuterol (Ventolin) 2.5 mg per nebulizer

A patient has acute bronchitis with a nonproductive cough and wheezes. Which topic should the nurse plan to include in the teaching plan? Appropriate use of cough suppressants Safety concerns with home oxygen therapy Purpose of antibiotic therapy Ways to limit oral fluid intake

Appropriate use of cough suppressants

A patient has just been admitted with probable bacterial pneumonia and sepsis. Which order should the nurse implement first? Blood cultures from two sites Acetaminophen (Tylenol) rectal suppository Chest x-ray via stretcher Ciprofloxacin (Cipro) 400 mg IV

Blood cultures from two sites

The major advantage of a Venturi mask is that it can a. deliver up to 80% O2. b. provide continuous 100% humidity. c. deliver a precise concentration of O2. d. be used while a patient eats and sleeps.

C

The nurse can best determine adequate arterial oxygenation of the blood by assessing a. heart rate. b. hemoglobin level. c. arterial oxygen tension. d. arterial carbon dioxide tension.

C

A patient is seen at the clinic with fever, muscle aches, sore throat with yellowish exudate, and headache. The nurse anticipates that the collaborative management will include (select all that apply) a. antiviral agents to treat influenza. b. treatment with antibiotics starting ASAP. c. a throat culture or rapid strep antigen test. d. supportive care, including cool, bland liquids. e. comprehensive history to determine possible etiology.

C, D, E

A patient with TB has been admitted to the hospital and is placed in an airborne infection isolation room. What should the patient be taught (select all that apply)? a. Expect routine TST to evaluate infection. b. Visitors will not be allowed while in airborne isolation. c. Take all medications for full length of time to prevent multidrug-resistant TB. d. Wear a standard isolation mask if leaving the airborne infection isolation room. e. Maintain precautions in airborne infection isolation room by coughing into a paper tissue.

C, D, E

During the respiratory assessment of the older adult, the nurse would expect to find (select all that apply) a. a vigorous cough. b. increased chest expansion. c. increased residual volume. d. increased breath sounds in the lung apices. e. increased anteroposterior (AP) chest diameter

C, E

An appropriate nursing intervention for a patient with pneumonia with the nursing diagnosis of ineffective airway clearance related to thick secretions and fatigue would be to a. perform postural drainage every hour. b. provide analgesics as ordered to promote patient comfort. c. administer O2 as prescribed to maintain optimal oxygen levels. d. teach the patient how to cough effectively to bring secretions to the mouth.

D

Which assessment finding of the respiratory system does the nurse interpret as abnormal? a. Inspiratory chest expansion of 1 in b. Percussion resonance over the lung bases c. Symmetric chest expansion and contraction d. Bronchial breath sounds in the lower lung fields

D

An 81-year-old patient who has been in the intensive care unit (ICU) for a week is now stable and transfer to the progressive care unit is planned. On rounds, the nurse notices that the patient has new onset confusion. The nurse will plan to notify the health care provider and postpone the transfer. obtain an order for restraints as needed and transfer the patient. inform the receiving nurse and then transfer the patient. give PRN lorazepam (Ativan) and cancel the transfe

inform the receiving nurse and then transfer the patient.

To verify the correct placement of an oral endotracheal tube (ET) after insertion, the best initial action by the nurse is to auscultate for the presence of bilateral breath sounds. use an end-tidal CO2 monitor to check for placement in the trachea. observe the chest for symmetric chest movement with ventilation. obtain a portable chest x-ray to check tube placement.

use an end-tidal CO2 monitor to check for placement in the trachea.