Chapter 50: Respiratory Problems of the Adult Client
A client with Acquired immunodeficiency syndrome (AIDS) has histoplasmosis. The nurse should assess the client for which expected finding? 1. Dyspnea 2. Headache 3. Weight gain 4. Hypothermia
Answer: 1. Dypnea
The nurse is taking the history of a client with occupational lung disease (silicosis). The nurse should assess whether the client wears which item during periods of exposure to silica particles? 1. Mask 2. Gown 3. Gloves 3. Eye protection
Answer: 1. Mask
A client who is HIV positive has had a tuberculin skin test (TST). The nurse notes a 7-mm area of induration at the site of the skin test and interprets the result as which finding? 1. Positive 2. Negative 3. Inconclusive 4. Need for repeating test
Answer: 1. Positive
The emergency department nurse is assessing a client who has sustained a blunt injury to the chest wall. Which finding indicates the presence of a pneumothorax in this client? 1. A low respiratory rate 2. Diminished breath sounds 3. The presence of a barrel chest 4. A sucking sound at the site of injury
Answer: 2. Diminished breath sounds
The nurse is preparing to give a bed bath to an immobilized client with tuberculosis. The nurse should wear which item when preforming this care:? 1. Surgical mask and gloves 2. Particulate respirator, gown, and gloves 3. particulate respirator and protective eyewear 4. Surgical mask, gown, and protective eyewear
Answer: 2. Particulate respirator, gown, and gloves
The nurse is caring for a client after a bronchoscopy and biopsy. Which finding, if noted in the client, should be reported immediately to the primary health care provider? 1. Dry cough 2. Hematuria 3. Bronchospasm 4. Blood-streaked sputum
Answer: 3. Bronchospasm
A client has experienced pulmonary embolism. The nurse should assess for which symptom, which is most commonly reported? 1. Hot, flushed feeling 2. Sudden chills and fever 3. Chest pain that occurs suddenly 4. Dyspnea when deep breaths are taken
Answer: 3. Chest pain that occurs suddenly
A client with a chest injury has suffered flail chest. The nurse assesses the client for which most distinctive sign of flail chest? 1. Cyanosis 2. Hypotension 3. Paradoxical chest movement 4. Dyspnea, especially on exhalation
Answer: 3. Paradoxical chest movement
The nurse performs an admission assessment on a client with a diagnosis of tuberculosis. The nurse should check the results of which diagnostic test that will confirm the diagnosis? 1. Chest x-ray 2. Bronchoscopy 3. Sputum culture 4. Tuberculin skin test
Answer: 3. Sputum culture
The nurse is assessing a client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse should assess for which earliest sign of acute respiratory distress syndrome? 1. Bilateral wheezing 2. Inspiratory crackles 3. Intercostal retractions 4. Increased respiratory rate
Answer: 4. Increased Respiratory rate
The nurse is assessing the respiratory status of a client who has suffered a fractured rib. The nurse should expect to note which finding? 1. Slow, deep respirations 2. Rapid, deep respirations 3. Paradoxical respirations 4. Pain, especially with inspirations
Answer: 4. Pain, especially with inspirations
The nurse provides discharge instructions to a patient who was hospitalized for pulmonary sarcoidosis. The nurse concludes that the client understands the information if the client indicates to report which early sign of exacerbation? 1. Fever 2. Fatigue 3. Weight loss 4. Shortness of breath
Answer: 4. Shortness of breath
The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which position should the nurse instruct the patient to client to assume? 1. Sitting up in bed 2. Side-lying position 3. sitting up in a recliner chair 4. sitting up and leaning over an overbed table
Answer: 4. sitting up leaning over an overbed table
The nurse has conducted discharge teaching with a client diagnosed with tuberculosis who has been receiving medication for 2 weeks. The nurse determines that the client has understood the information if the client makes which statement? 1. "I need to continue medication therapy for 1 month" 2. "I can't shop at the mall for the next 6 months" 3. "I can return to work if a sputum culture comes back negative" 4. "I should not be contagious after 2 to 3 weeks weeks of medication"
Answer: 4:"I should not be contagious after 2 to 3 weeks weeks of medication"
The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for tuberculosis. Which instructions should the nurse include on the list? Select all that apply. 1. Activities should be resumed gradually 2. Avoid contact with other individuals, except family members, for at least 6 months 3. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated" 4. ""Respiratory isolation is not necessary, because family members already have been exposed" 5. "Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags" 6. When 1 sputum culture is negative, the client is no longer considered infectious and usually can return to former employment.
Answers: 1. Activities should be resumed gradually 3. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated." 4. ""Respiratory isolation is not necessary, because family members already have been exposed" 5. "Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags"
The community health nurse is conducting an educational session with community members regarding the signs and symptoms associated with tuberculosis. The nurse informs the participants that tuberculosis is considered as a diagnosis if which signs and symptoms are present? Select all that apply. 1. Dyspnea 2. Headache 3. Night sweats 4. A bloody, productive cough 5. A cough with the expectoration of mucoid sputum
Answers: 1. Dyspnea 3. Night sweats 4. A bloody, productive cough 5. A cough with the expectoration of mucoid sputum
The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which findings, would the nurse expect to note on assessment of the client? Select all that apply? 1. A low arterial PCo2 level 2. A hyperinflated chest noted on the chest x-ray 3. Decreased oxygen saturation with mild exercise 4. A widened diaphragm noted on the chest x-ray Pulmonary function tests that demonstrate increased vital capacity
Answers: 2. A hyperinflated chest noted on the chest x-ray 3. Decreased oxygen saturation with mild exercise