Ch. 23 PrepU
A client is being evaluated for possible lung cancer. Which client statement most likely indicates lung cancer?
"My cough has changed from a dry cough to one with lots of sputum production."
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"
The nurse is administering anticoagulant therapy with heparin. What International Normalized Ratio (INR) would the nurse know is within therapeutic range?
2.0-2.5
A client with pulmonary hypertension has a positive vasoreactivity test. What medication does the nurse anticipate administering to this client?
Calcium channel blockers
Class 1 with regard to TB indicates
Exposure and no evidence of infection
In a client with amyotrophic lateral sclerosis (ALS) and respiratory distress, which finding is the earliest sign of reduced oxygenation?
Increased restlessness
A client with suspected severe acute respiratory syndrome (SARS) comes to the emergency department. Which physician order should the nurse implement first?
Institute isolation precautions
Which action by the nurse is most appropriate when the client demonstrates subcutaneous emphysema along the suture line or chest dressing 2 hours after chest surgery?
Record the observation
In the prevention of occupational lung diseases, the nurse would direct preventive teaching to which high-risk occupations?
Rock quarry worker Miner Stone cutter
The nurse assesses a patient for a possible pulmonary embolism. What frequent sign of pulmonary embolus does the nurse anticipate finding on assessment?
Tachypnea
A client is being discharged following pelvic surgery. What would be included in the patient care instructions to prevent the development of a pulmonary embolus?
Tense and relax muscles in the lower extremities
A mediastinal shift occurs in which type of chest disorder?
Tension pneumothorax
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.
Which statement would indicate that the parents of child with cystic fibrosis understand the disorder?
The mucus-secreting glands are abnormal
Which technique does the nurse suggest to a client with pleurisy while teaching about splinting the chest wall?
Turn onto the affected side
A nurse is aware that the diagnostic feature of ARDS is sudden:
Unresponsive arterial hypoxemia
A nurse is giving a speech addressing "Communicable Diseases of Winter" to a large group of volunteer women, most of whom are older than 60 years. What preventive measures should the nurse recommend to these women, who are at the risk of pneumococcal and influenza infections?
vaccinations, hand antisepsis
A client who is diagnosed with chronic respiratory failure will have which symptom?
dyspnea
A client with a pulmonary embolus has the following arterial blood gas (ABG) values: pH, 7.49; partial pressure of arterial oxygen (PaO2), 60 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 30 mm Hg; bicarbonate (HCO3-) 25 mEq/L. What should the nurse do first?
Administer oxygen by nasal cannula as ordered
The nurse is auscultating the patient's lung sounds to determine the presence of pulmonary edema. What adventitious lung sounds are significant for pulmonary edema?
Crackles in the lung bases
A client with unresolved hemothorax is febrile, with chills and sweating. He has a nonproductive cough and chest pain. His chest tube drainage is turbid. A possible explanation for these findings is:
Empyema
A mechanically ventilated client is receiving a combination of atracurium and the opioid analgesic morphine. The nurse monitors the client for which potential complication?
Venous thromboemboli
A client with severe shortness of breath comes to the emergency department. He tells the emergency department staff that he recently traveled to China for business. Based on his travel history and presentation, the staff suspects severe acute respiratory syndrome (SARS). Which isolation precautions should the staff institute?
Airborne and contact precautions
The nursing instructor is discussing pulmonary arterial hypertension with the nursing students. What would the instructor describe as the pathophysiology of secondary pulmonary arterial hypertension?
Alveolar destruction causes increased resistance and pressure in the pulmonary vascular bed.
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?
Applying a sequential compression device Instructing the client to move the legs in a 'pumping' exercise Using elastic stockings, especially when decreased mobility would promote venous stasis Encouraging a liberal fluid intake
The clinic nurse is caring for a client with acute bronchitis. The client asks what may have caused the infection. What may induce acute bronchitis?
Chemical irritation
An emergency room nurse is assessing a client who is complaining of dyspnea. Which sign would indicate the presence of a pleural effusion?
Decreased chest wall excursion upon palpation
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?
Do not smoke, or quit smoking if you currently smoke. Weak appropriate protective equipment when around airborne irritants and dusts.
For a client with pleural effusion, what does chest percussion over the involved area reveal?
Dullness over the area involved
A client has hypoxemia of pulmonary origin. What portion of arterial blood gas results is most useful in distinguishing between acute respiratory distress syndrome and acute respiratory failure?
Partial pressure of arterial oxygen (PaO2)
The nurse caring for a 2-year-old near-drowning victim monitors for what possible complication?
ARDS
A client comes to the health clinic after a positive skin test for tuberculosis. What additional diagnostic tests should the nurse begin teaching the client?
Chest xray, Complete history and physical examination, drug susceptibility testing
The nurse is assessing a patient who has been admitted with possible ARDS. What findings would distinguish ARDS from cardiogenic pulmonary edema?
Elevated B-type natriuretic peptide (BNP) levels
Which interventions does a nurse implement for clients with empyema?
Encourage breathing exercises
Following thoracic surgery, what should the nurse include in the care plan for a client at risk for impaired gas exchange?
Monitor vital signs frequently Reinforce preoperative breathing exercises Elevate head of the bed 30-40 degrees as tolerated Administer pain medications
A nurse is caring for a client who was admitted with pneumonia, has a history of falls, and has skin lesions resulting from scratching. The priority nursing diagnosis for this client should be:
Ineffective airway clearance
A client admitted with pneumonia has a history of lung cancer and heart failure. A nurse caring for this client recognizes that he should maintain adequate fluid intake to keep secretions thin for ease in expectoration. The amount of fluid intake this client should maintain is:
2L
A patient taking isoniazid (INH) therapy for tuberculosis demonstrates understanding when making which statement?
"It is all right if I have a grilled cheese sandwich with American cheese."
Acute respiratory failure (ARF) occurs when oxygen tension (PaO2) falls to less than __________ mm Hg (hypoxemia) and carbon dioxide tension (PaCO2) rises to greater than __________ mm Hg (hypercapnia).
60; 50
A client is admitted to the emergency department with a stab wound and is now presenting dyspnea, tachypnea, and sucking noise heard on inspiration and expiration. The nurse should care for the wound in which manner?
Apply airtight dressing
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
The nurse caring for a client with tuberculosis anticipates administering which vitamin with isoniazid (INH) to prevent INH-associated peripheral neuropathy?
Vitamin B6
Which vitamin is usually administered with isoniazid (INH) to prevent INH-associated peripheral neuropathy?
Vitamin B6
A client is admitted to the health care facility with active tuberculosis (TB). What intervention should the nurse include in the client's care plan?
Wearing a disposable particulate respirator that fits snugly around the face
The nurse is having an information session with a women's group at the YMCA about lung cancer. What frequent and commonly experienced symptom should the nurse be sure to include in the session?
coughing
Arterial blood gas analysis would reveal which value related to acute respiratory failure?
pH 7.28
A client continues to report dyspnea on exertion and overall weakness. A pulmonary artery catheter is placed and the mean pulmonary arterial pressure is 35 mm Hg. What condition is the client experiencing?
pulmonary arterial hypertension
The client with a lower respiratory airway infection is presenting with the following symptoms: fever, chills, dry hacking cough, and wheezing. Which nursing diagnosis best supports the assessment by the nurse?
Ineffective Airway clearance
A nurse is reviewing a client's X-ray. The X-ray shows an endotracheal (ET) tube placed 3/4" (2 cm) above the carina and reveals nodular lesions and patchy infiltrates in the upper lobe. Which interpretation of the X-ray is accurate?
A disease process is present
A client admitted to the facility for treatment for tuberculosis receives instructions about the disease. Which statement made by the client indicates the need for further instruction?
"I'll stay in isolation for 6 weeks."
A client who has started therapy for drug-resistant tuberculosis demonstrates understanding of tuberculosis transmission when he says:
"I'll stop being contagious when I have a negative acid-fast bacilli test."
Which type of lung cancer is the most prevalent among both men and women?
Adenocarcinoma
A nurse is caring for a client after a thoracentesis. Which sign, if noted in the client, should be reported to the physician immediately?
Client is becoming agitated and complains of pleuritic pain
A physician determines that a client has been exposed to someone with tuberculosis. The nurse expects the physician to order which treatment?
Daily doses of isoniazid, 300 mg for 6-12 months
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
Which community-acquired pneumonia demonstrates the highest occurrence during summer and fall?
Legionnaires disease
Which type of pneumonia has the highest incidence in clients with AIDS and clients receiving immunosuppressive therapy for cancer?
Pneumocystis
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
A nurse assesses a client with pneumonia. Which assessments are diagnostic for pneumonia?
Presence of crackles, Egophony, Wheezes, Whispered pectoriloquy, Percussion dullness
Influenza, an annual epidemic in the U.S., creates a significant increase in hospitalizations and an rise in the death rates from pneumonia and cardiovascular disease. Besides death, what is the most serious complication of influenza?
Staphylococcal pneumonia
A client involved in a motor vehicle crash suffered a penetrating injury to the chest wall and was brought to the emergency department. The nurse assesses the client for which clinical manifestation that would indicate the presence of a pneumothorax?
Sucking sound at the site of injury
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
A patient who wears contact lenses is to be placed on rifampin for tuberculosis therapy. What should the nurse tell the patient?
You should switch to wearing your glasses while taking this medication.
