EXAM 1 NUR107

Which category of medications may be administered by nebulizer or metered-dose inhaler to open narrowed airways?

Bronchodialators

A nurse is educating a postoperative client on how to use an incentive spirometer. What is an accurate step that should be included in the education plan?

Instruct the client to inhale slowly and as deeply as possible through the mouthpiece, without using the nose.

After talking with a group of staff nurses on the medical-surgical unit, the nurse manager identifies a need for change. When developing a plan for change, which question would the nurse manager need to ask first?

Is the behavior something that can be changed?

A nurse uses a nasal cannula to deliver oxygen to a client who is extremely hypoxic and has been diagnosed with chronic lung disease. What is the most important thing to remember when using a nasal cannula?

It can cause the nasal mucosa to dry in case of high flow.

A client is being discharged to home following a diagnosis of lung carcinoma and subsequent treatment with pneumectomy surgery. The client has a prescription for continuous home oxygen. Which measure(s) will the nurse include in a teaching plan aimed at increasing oxygen-related home safety?

Post a "no smoking" sign in a conspicious area. Use caution with gas or electrical appliances.

Martin is a 58-year-old smoker who was admitted to the hospital with worsening shortness of breath over the last 2 days. He states that he is having some chest discomfort. The nurse asks him further about this in order to characterize whether this may be cardiac related, musculoskeletal related, or respiratory related. Martin states that when he breathes in, he feels as if the air passing into his lungs is burning him. It is also very painful to swallow. Based on what Martin is stating, which illness does the nurse suspect is causing Martin's chest discomfort?

acute bronchitis

Autocratic leadership

also called directive leadership or authoritarian leadership, involves the leader assuming control over the decisions and activities of the group. It is often an efficient process, yet many people may resent this leadership approach when used regularly. Staff and team members have limited opportunity to contribute suggestions and participate in organizational decisions. High staff turnover and burnout are more common with this style of leadership.

laissez-faire leadership

also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. This approach encourages independent activity by group members. This style depends on the strengths of followers to direct the group activities. It is most effective when all staff are clinical experts with a deep understanding of both clinical and administrative processes. This style is rarely useful because task achievement is difficult when each nurse is working independently, and the staff on most units and departments have varying levels of clinical maturity. However, it can be used effectively when the leader wants a problem to be solved completely by expert staff group members.

Democratic leadership

also called participative leadership, is characterized by a sense of equality among the leader and other participants. Decisions and activities are shared. Participants are encouraged to develop their skills and strengths within the group. The group and leader work together to accomplish mutually set goals and outcomes. As professionals, nurses generally respond well to this style of leadership when they are the followers and feel more comfortable when they are the leaders of democratic groups. Group satisfaction and motivation are excellent benefits of this style. In situations in which a rapid response is essential, however, a democratic approach to leadership that requires gathering the input of team members may slow decision making.

The nurse assessing a client with chronic obstructive pulmonary disease (COPD) suspects chronic hypoxia based on which assessment finding?

clubbing fingers

When a staff member has successfully completed the activities delegated by the nurse manager, the result is usually that the staff member is more:

committed

The nurse is preparing to delegate tasks to an unlicensed assistive personnel (UAP) for a client who recently had a stroke and is suffering from mil hemiplegia. Which task would be inappropriate for the nurse to delegate to the UAP?

feeding

The nurse is conducting a respiratory assessment of a client age 71 years who has been recently admitted to the hospital unit. Which assessment finding should the nurse interpret as abnormal?

fine crackles to the bases of the lungs bilaterally

A nurse must deliver oxygen at a concentration of 85% to an infant. Which delivery device would be most appropriate for an infant?

oxygen hood

A nurse is using the SBAR approach for handoff communication when transferring a client to the critical care unit. Which statement would the nurse include as part of the recommendation?

"The client is scheduled for a cardiac catheterization in about an hour and needs monitoring every 15 minutes."

Which one of the following respiratory organs is the site of gas exchange?

Alveoli- At the end of the terminal bronchioles, there are clusters of alveoli that are the site of gas exchange. The wall of each alveolus is made of a single-cell layer of squamous epithelium. This thin wall allows for exchange of gasses within the capillaries covering the alveoli.

The nurse is caring for a client receiving oxygen therapy via nasal cannula. The client suddenly becomes cyanotic with a pulse oximetry reading of 91%. What is the next most appropriate action the nurse should take?

Assess oxygen tubing connection

The nurse is assessing a client with lung cancer. What manifestations may suggest that the client has chronic hypoxia?

Clubbing

Competing:

Competing results in a win for one party at the expense of the other group.

The home care nurse visits a client who has dyspnea. The nurse notes the client has pitting edema in his feet and ankles. Which additional assessment would the nurse expect to observe?

Crackles in the lower lobes

The nurse is getting accustomed to the role of nurse manager. What are requirements for this nursing role? Select all that apply.

Creating schedules for the unit Managing the unit's operational budget Introducing methods to improve staff efficiency Evaluating the success of the unit policies

The nurse manager is concerned about staff being upset about the frequency of taking clients' vital signs and holds a meeting. The staff are allowed to make suggestions to amend the new policy and vote on which policy will be implemented. The nurse manager then makes the decision to implement the policy that is best. What types of leadership style(s) are being used by the nurse manager? Select all that apply

Directive Participative

The nurse manager is assisting the hospital to meet requirements for Magnet® recognition. Which measure should the nurse manager recognize as being a requirement for this recognition?

Encouraging reporting of errors or potential errors without fear of punishment

A nurse who is a discharge planner in a large metropolitan hospital is preparing a discharge plan for a patient after a kidney transplant. Which actions would this nurse typically perform to ensure continuity of care as the patient moves from acute care to home care? Select all that apply.

Evaluating the nursing plan for effectiveness of care Making referrals to appropriate facilities Assessing the strengths and limitations of the patient and family

A nurse manager who is attempting to institute the SBAR process to communicate with health care providers and transfer patient information to other nurses is meeting staff resistance to the change. Which action would be most effective in approaching this resistance?

Explaining the change and listing the advantages to the person and the organization

A patient with COPD is unable to perform personal hygiene without becoming exhausted. What nursing intervention would be appropriate for this patient?

Group personal care activities into smaller steps, allowing rest periods between activities.

A nurse is educating a client who has congested lungs on how to keep secretions thin and more easily coughed-up and expectorated. What would be one self-care measure to teach?

Increase oral intake of fluids to 2 to 3 quarts per day.

A health care provider orders the collection of a sputum specimen from a client with a suspected bacterial infection. Which action best ensures a usable specimen?

Instruct the client to inhale deeply and then cough.

Two nurses have requested that the nurse manager allow them to plan in-service education with creative, new education techniques. Which leadership style would be best for the nurse manager to use to get the new project completed?

Laissez-faire

How might one define leadership?

Leadership is the process of guiding, educating, motivating, and directing others.

The nurse is obtaining a pulse oximetry reading for a client admitted with exacerbation of chronic obstructive pulmonary disease (COPD). When observing a reading of 89%, what action should the nurse perform?

No action is required, because this may be normal for the client

Diffusion

Oxygen and carbon dioxide exchange in the lung's alveoli and capillaries occurs by diffusion or moving from higher concentration to lower concentration. Any disease or condition that results in thickening of the alveolar-capillary membrane, such as pneumonia or pulmonary edema, makes diffusion more difficult.

When a nurse observes that an older client's skin is dry and shiny and his nails are thickened, the nurse determines that the client is most likely experiencing

Poor tissue perfusion

Which nursing model results in the greatest continuity of care?

Primary nursing

A nurse in an intensive care unit places a request with the nurse manager to modify the nurse's work schedule. The nurse desires to return to college and obtain an advanced nursing degree. Which action by the nurse manager in response to the nurse's request illustrates the transformational style of leadership?

Rearranging the nurse's schedule such that the nurse can attend college

A nurse working in a long-term care facility is providing teaching to patients with altered oxygenation due to conditions such as asthma and COPD. Which measures would the nurse recommend? Select all that apply.

Reduce anxiety. Eat a high-protein/high-calorie diet. Maintain a high-Fowler's position when possible.

A nurse manager of a busy cardiac unit observes disagreements between the RNs and the LPNs related to schedules and nursing responsibilities. At a staff meeting, the manager compliments all the nurses on a job well done and points out that expected goals and outcomes for the month have been met. The nurse concludes the meeting without addressing the disagreements between the two groups of nurses. Which conflict resolution strategy is being employed by this manager? Collaborating Competing Compromising Smoothing

Smoothing- The manager who resolves conflict by complimenting the parties involved and focusing on agreement rather than disagreement is using smoothing to reduce the emotion in the conflict. The original conflict is rarely resolved with this technique

When inspecting a client's chest to assess respiratory status, the nurse should be aware of which normal finding?

The chest should be slightly convex with no sternal depression.

A physician prescribes the use of water-seal chest tube drainage for a client at a health care facility. What should the nurse ensure when using the water-seal chest tube drainage?

The chest tube should not be separated from the drainage system unless clamped.

A nurse takes a client's pulse oximetry reading and finds that it is normal. What does this finding indicate?

The client's available hemoglobin is adequately saturated with oxygen.

A nurse coordinator for a busy hospital provides for continuity of care for clients using the hospital services. Which cognitive skill would this nurse need to ensure continuity of care?

The knowledge of how to communicate client priorities and the related plan of care as a client is transferred between different settings

A nurse manager of a physician's office uses the laissez-faire style of leadership with the staff. Which nursing actions reflect this management style? Select all that apply

The nurse manager allows self-scheduling. The nurse manager allows dominant staff members to direct the group activities. Manager and staff work independently, making task accomplishment difficult.

A nurse is preparing an infant and his family for a hernia repair to be performed in an ambulatory care facility. What is the primary role of the nurse during the admission process?

To assess what has been done and what still needs to be done

A nurse is working as part of a group on developing strategies to meet the health care needs of the children being served by the facility. The nurse identifies the need for expanded play therapy programs. The nurse works to motivate others in the group and promote a common vision. The nurse and the group communicate openly and honestly with the others involved, focusing on the process as well as the outcomes. The nurse is exhibiting which style of leadership?

Transformational

Lewin three stages of change:

Unfreezing: The need for change is recognized. Moving: Change is initiated after a careful process of planning. Refreezing: Change becomes operational.

During data collection, the nurse auscultates low-pitched, soft sounds over the lungs' peripheral fields. Which appropriate terminology would the nurse use to describe these lung sounds when documenting?

Vesicular

What prevents air from reentering the pleural space when chest tubes are inserted?

a closed water-seal drainage system

Collaborating:

a joint effort to resolve the conflict with a win-win solution. All parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal.

Of all factors, what is the most important risk factor in pulmonary disease?

active and passive cigarette smoke

The nurse is caring for a client who has a compromised cardiopulmonary system and needs to assess the client's tissue oxygenation. The nurse would use which appropriate method to assess this client's oxygenation?

arterial blood gas

The nurse is caring for a postoperative adult client who has developed pneumonia. The nurse should assess the client frequently for symptoms of:

atelectasis

Upon auscultation of the client's lungs, the nurse hears loud, high-pitched sounds over the larynx. What term will the nurse use in documentation to describe this breath sound?

bronchial

A nurse is reading a journal article about pollutants and their effect on an individual's respiratory function. Which problem would the nurse most likely identify as an effect of exposure to automobile pollutants?

bronchitis

Transformational leadership

can create revolutionary change. Often described as charismatic, transformational leaders are unique in their ability to inspire and motivate others.

Which medication is administered in the home or the hospital to relieve inflammation in the lung tissue?

corticosteroids

The nurse auscultates a client with soft, high-pitched popping breath sounds on inspiration. The nurse documents the breath sounds heard as:

crackles

Mr. Parks has chronic obstructive pulmonary disease (COPD). His nurse has taught him pursed-lip breathing, which helps him in which of the following ways?

decreases the amount of air trapping and resistance

A nurse is caring for a patient with COPD. What would be an expected finding upon assessment of this patient?

dyspnea

The nurse is implementing an order for oxygen for a client with facial burns. Which delivery device will the nurse gather?

face tent

An older adult client is visibly pale with a respiratory rate of 30 breaths per minute. Upon questioning, the client states to the nurse, "I can't seem to catch my breath." The nurse has responded by repositioning the client and measuring the client's oxygen saturation using pulse oximetry, yielding a reading of 90%. The nurse should interpret this oxygen saturation reading in light of the client's:

hemoglobin level

Pulmonary Ventilation

is the movement of air into and out of the lungs

Perfusion

is the process by which oxygenated capillary blood passes through body tissues.

A nurse manager is changing the policy for scheduling staff on a critical care unit. The schedules will be changed and an announcement was made regarding this to the staff. Based on Lewin's change theory, in what stage of change is the manager participating?

moving

Compromising:

occurs when both parties relinquish something of equal value.

The role of management:

plan, organize, direct, and control available human, material, and financial resources to deliver quality care to patients and families.

While auscultating a client's chest, the nurse auscultates crackles in the lower lung bases. What condition does the nurse identify the client is experiencing?

presence of fluid in the lungs

A nurse is educating a home care client on how to do pursed-lip breathing. What is the therapeutic effect of this procedure?

prolonging expiration to reduce airway resistance

Which diagnostic procedure measures lung size and airway patency, producing graphic representations of lung volumes and flows?

pulmonary function test

A nurse is caring for a patient who has been hospitalized for an acute asthma exacerbation. Which testing method might the nurse use to measure the patient's oxygen saturation?

pulse oximetry

When reviewing data collection on a client with a cardiac output of 2.5 liter/minute, the nurse inspects the client for which symptom?

rapid respirations

The nurse auscultates the lungs of a client with asthma who reports shortness of breath, sore throat, and congestion. Which finding does the nurse expect to document?

wheezing

The nurse is caring for a client who has had a percutaneous tracheostomy (PCT) following a motor vehicle accident and has been prescribed oxygen. What delivery device will the nurse select that is most appropriate for this client?

tracheostomy collar

A nurse suctioning a client through a tracheostomy tube should be careful not to occlude the Y-port when inserting the suction catheter because it would cause what condition to occur?

trauma to tracheal mucosa