EXAM 2 NP3

What discharge teaching would you give to a client with acute lymphocytic leukemia that has developed leukopenia?

"I should avoid contact with people who might give me an infection"

The physician has scheduled a client for a left pneumonectomy. The position that will most likely be ordered postoperatively for his is the: A. Nonoperative side or back B. Operative side or back C. Back only D. Back or either side

B. Operative side or back

The nurse is assessing a patient whose respiratory disease is characterized by chronic hyperinflation of the lungs. What would the nurse most likely assess in this patient? A) Signs of oxygen toxicity B) Chronic chest pain C) A barrel chest D) Long, thin fingers

C) A barrel chest

A Patient with chronic lung disease is undergoing lung function testing. What test result denotes the volume of air inspired and expired with a normal breath? A) Total lung capacity B) Forced vital capacity C) Tidal volume D) Residual volume

C) Tidal volume

What significant risk factors in reducing many types of cancer?

- Increased emphasis on education & awareness - Greater emphasis on prevention and early intervention - Advancements in diagnosis and treatment - Policies and programs designed to decrease environmental risks (not smoking)

Which laboratory findings are indicative of the massive cell destruction that occurs with chemotherapy?

- Increased uric acid level

What are the expected labs for a patient with multiple myeloma?

- Monoclonal protein - immunoglobin present in blood and urine

What education would you give a patient with a low WBC count?

- They are at a higher risk for infection

A client is being prepared for a thoracentesis. The nurse should assist the client to which position for the procedure? 1. Lying in bed on the affected side. 2. Lying in bed on the unaffected side 3. Sims' position with the head of the bed flat 4. Prone with the head turned to the side and supported by a pillow.

2. Lying in bed on the unaffected side

A female client is scheduled to have a chest radiograph. Which question is most important for the nurse to ask when assessing this client? 1. "Can you hold your breath easily?" 2. "Are you wearing any metal chains or jewelry?" 3. "Are you able to hold your arms above your head?" 4. "Is there any possibility that you could be pregnant?"

4. "Is there any possibility that you could be pregnant?"

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 client to assume? 1. Sitting up in bed 2. Side-lying in bed 3. Sitting in a recliner chair 4. Sitting up and leaning on an overbed table

4. Sitting up and leaning on an overbed table

A patient that has been diagnosed with cancer has cachexia. What is cachexia?

A complex metabolic syndrome characterized by muscle loss with or without fat mass loss and associated with an underlying illness. The prominent clinical feature is weight loss, poor health, malnutrition, emaciation

The nurse is teaching a client with COPD how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing. Which explanation should the nurse provide? A) It helps prevent early airway collapse B) It increases inspiratory muscle strength C) It decreases use of accessory breathing muscles D) It prolongs the inspiratory phase of respiration

A) It helps prevent early airway collapse

The nurse is caring for a patient who has returned to the unit following a bronchoscopy. The patient is asking for something to drink. Which criterion will determine when the nurse should allow the patient to drink fluids? A) Presence of a cough and gag reflex B) Absence of nausea C) Ability to demonstrate deep inspiration D) Oxygen saturation of 92%

A) Presence of a cough and gag reflex

A Patient with emphysema is experiencing shortness of breath. To relieve this patient's symptoms, the nurse should assist her into what position? A) Sitting upright, leaning forward slightly B) LowFowlers, with the neck slightly hyperextended C) Prone D) Trendelenburg

A) Sitting upright, leaning forward slightly

The nurse is discussing the dietary changes for a client with chronic obstructive pulmonary disease. Which advice should the nurse include? A. Follow a low-salt diet B. Restrict fluids C. Increased dietary intake D. Follow a high-carbohydrates diet

A. Follow a low-salt diet

Which of the following is an expected outcome of pursed lip breathing for a client with emphysema? A. To promote carbon dioxide elimination B. To promote oxygen intake C. To strengthen the diaphragm D. To strengthen the intercostal muscles

A. To promote carbon dioxide elimination

An appropriate problem statement for a patient with pulmonary edema is Fluid Volume Overload, related to altered tissue permeability. Which nursing interventions for this patient problem statement are correct? a. Assess indicators of patients fluid volume status, such as breath sounds, skin turgor, and pedal, sacral, and periorbital edema b. Monitor intake and output accurately c. Administer diuretics as ordered d. Weigh daily

All of the above

A client has active TB. Which of the following symptoms will he exhibit? A) Chest and lower back pain B) Chills, fever, night sweats, and hemoptysis C) Fever of more than 104*F and nausea D) Headache and photophobia

B) Chills, fever, night sweats, and hemoptysis

A nurse is teaching a client with cystic fibrosis about daily chest physiotherapy (chest percussion & vibration). Which of the following is the purpose of these treatments? A. - To encourage deep breaths B. - To mobilize secretions in the airways C. - To dilate the bronchioles D. - To stimulate the cough reflex

B. - To mobilize secretions in the airways

A client is admitted to the hospital with acute bronchitis. While taking the client's VS, the nurse notices he has an irregular pulse. The nurse understands that cardiac arrhythmias in chronic respiratory distress are usually the result of: A. Respiratory acidosis B. A build-up of carbon dioxide C. A build-up of oxygen without adequate expelling of carbon dioxide. D. An acute respiratory infection.

B. A build-up of carbon dioxide

How would you as a nurse meet the physical activity needs of a cancer patient with debilitating fatigue? A. Teach the patient about the risks of immobility and the benefits of exercise B. Assist the patient to a chair during awake times, as tolerated C. Collaborate with physical therapists to arrange for stair exercises D. Teach the patient to perform deep breathing and coughing exercises

B. Assist the patient to a chair during awake times, as tolerated

Assessing a client who has developed atelectasis postoperatively, the nurse will most likely find: A. A flushed face. B. Dyspnea and pain. C. Decreased temperature. D. Severe cough and no pain

B. Dyspnea and pain.

When caring for a patient with chronic obstructive pulmonary disease (COPD), the nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after noting a weight loss of 30 lb. Which intervention should the nurse add to the plan of care for this patient? A. Order fruits and fruit juices to be offered between meals. B. Order a high-calorie, high-protein diet with six small meals a day. C. Teach the patient to use frozen meals at home that can be microwaved. D. Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet.

B. Order a high-calorie, high-protein diet with six small meals a day.

Increased tactile fremitus would be evident in an individual who has which of the following conditions? A. Emphysema B. Pneumonia C. Crepitus D. Pneumothorax

B. Pneumonia

What is the highest priority nursing diagnoses for a client undergoing induction therapy for leukemia? A. Activity Intolerance B. Risk for Infection C. Acute Confusion D. Risk for Spiritual Distress

B. Risk for Infection

What are discharge instructions/precautions for a patient being treated for non-Hodgekin's lymphoma on an outpatient basis? A. Avoiding direct sun exposure more than 15 minutes B. Avoid grapefruit juice and fresh grapefruit C. Avoid highly crowded public places D. Use an electric shaver rather than a razor

C. Avoid highly crowded public places

A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in clients with asthma? A. Corticosteroids promote bronchodilation. B. Corticosteroids act as an expectorant. C. Corticosteroids have an anti-inflammatory effect. D. Corticosteroids prevent development of respiratory infections

C. Corticosteroids have an anti-inflammatory effect.

The spouse of a 78-year-old client who was discharged to home 1 day ago after hospitalization for seasonal influenza calls to report the fever has returned and is now 103.4 degrees F. What is the nurse's primary concern for this client? A. The client may not be taking the prescribed antiviral drug correctly B. A second strain of influenza is likely C. Pneumonia may be present D. The client may be dehydrated

C. Pneumonia may be present

The most reliable index to determine the respiratory status of a client is to: A.) Observe the chest rising and falling. B.) Observe the skin and mucous membrane color. C.) Listen and feel the air movement. D.) Determine the presence of a femoral pulse.

C.) Listen and feel the air movement.

The nurse is teaching a client how to use a metered-dose inhaler. Place in order the steps the nurse will use for instruction. 1. Place the inhaler mouthpiece in your mouth 2. Exhale 3. Hold your breath for 5-10 seconds. 4. Press the canister down to deliver a dose of medication and breathe in. 5. Twist the canister into the inhaler unit and shake the inhaler.

Correct 5,2,1,4,3

A nurse is explaining to a patient with asthma what her new prescription for prednisone is used for. What would be the most accurate explanation that the nurse could give? A) To ensure long-term prevention of asthma exacerbations B) To cure any systemic infection underlying asthma attacks C) To prevent recurrent pulmonary infections D) To gain prompt control of inadequately controlled, persistent asthma

D) To gain prompt control of inadequately controlled, persistent asthma

The nurse is caring for a patient who has been scheduled for a bronchoscopy. How should the nurse prepare the patient for this procedure? A) Administer a bolus of IVfluids. B) Arrange for the insertion of a peripherally inserted central catheter. C) Administer nebulized bronchodilators every 2 hours until the test. D) Withhold food and fluids for several hours before the test

D) Withhold food and fluids for several hours before the test.

Which of the following diets would be most appropriate for a client with COPD? A. Low fat, low cholesterol B. Bland, soft diet C. Low-Sodium diet D. High calorie, high-protein diet

D. High calorie, high-protein diet

A nurse is reinforcing preoperative teaching with a client who is to undergo a pneumonectomy. The client states, "I am afraid it will hurt to cough after the surgery." Which of the following statements by the nurse is appropriate? A. "After the surgeon removes the lung, you will not need to cough." B. "I'll make sure you get a cough suppressant to keep you from straining the incision when you cough." C. "Don't worry. You will have a pump that delivers pain medication as you need it, so you will have very little pain." D."I will show you how to splint your incision while coughing."

D."I will show you how to splint your incision while coughing."

The presence of what assessment finding is considered diagnostic of Hodgkin's lymphoma?

Reed-Sternberg cells

You are taking care of a patient with severe COPD. What type of diet would best suit this patient's needs?

The best option here is pureed sweet potatoes, ground turkey & gravy with mashed potatoes.

A client with COPD reports steady weight loss and being "too tired from just breathing to eat." Which of the following nursing diagnoses would be most appropriate when planning nutritional interventions for this client? a. Altered nutrition: Less than body requirements related to fatigue. b. Activity intolerance related to dyspnea. c. Weight loss related to COPD. d. Ineffective breathing pattern related to alveolar hypoventilation.

a. Altered nutrition: Less than body requirements related to fatigue.

The nurse caring for a client with a pneumothorax and who has had a chest tube inserted notes continuous gentle bubbling in the suction control chamber. What action is most appropriate? a. Do nothing, because this is an expected finding b. Check for an air leak because the bubbling should be intermittent c. Increase the suction pressure so that the bubbling becomes vigorous d. Immediately clamp the chest tube and notify the health care provider

a. Do nothing, because this is an expected finding

Inability to Clear Airways, related to tracheobronchial obstruction or secretions, is a problem statement for a patient with COPD. Which nursing interventions are correct? a. Encourage generous fluid intake b. Have the patient turn and cough every 2 hours c. Teach effective coughing technique

a. Encourage generous fluid intake b. Have the patient turn and cough every 2 hours c. Teach effective coughing technique

Which of the following physical assessment findings would the nurse expect to find in a client with advanced COPD? a. Increased anteroposterior chest diameter "Aka Barrel chest" b. Underdeveloped neck muscles c. Collapsed neck veins d. Increased chest excursions with respiration

a. Increased anteroposterior chest diameter "Aka Barrel chest"

Which of the following is a priority goal for the client with COPD? a. Maintaining functional ability b. Minimizing chest pain c. Increasing carbon dioxide levels in the blood d. Treating infectious agents

a. Maintaining functional ability

For a client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the care plan? a. Measuring and documenting the drainage in the collection chamber b. Maintaining continuous bubbling in the water-seal chamber c. Keeping the collection chamber at chest level d. Stripping the chest tube every hour

a. Measuring and documenting the drainage in the collection chamber

A patient with recurrent shortness of breath has just had a bronchoscopy. What is a priority nursing action immediately following the procedure? a. Monitor the patient for laryngeal edema. b. Assess the patient's level of consciousness (LOC). c. Monitor and manage the patient's level of pain. d. Assess the patient's heart rate and blood pressure

a. Monitor the patient for laryngeal edema.

The client is diagnosed with pleurisy. The nurse should expect to see which signs and symptoms? Select all that apply. a. Pleural friction rub b. 2.Sharp, knife-like pain c. Pain that occurs most often during inspiration

a. Pleural friction rub b. 2.Sharp, knife-like pain c. Pain that occurs most often during inspiration

A nurse is admitting a new patient who has been admitted with a diagnosis of COPD exacerbation. How can the nurse best help the patient achieve the goal of maintaining effective oxygenation? a. Teach the patient strategies for promoting diaphragmatic breathing. b. Administer supplementary oxygen by simple face mask. c. Teach the patient to perform airway suctioning. d. Assist the patient in developing an appropriate exercise program.

a. Teach the patient strategies for promoting diaphragmatic breathing.

A nurse is suctioning fluids from a female client through an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which of the following is the appropriate nursing intervention? a. Continue to suction. b. Notify the physician immediately. c. Stop the procedure and reoxygenate the client. d. Ensure that the suction is limited to 15 seconds.

c. Stop the procedure and reoxygenate the client.

The health care provider has prescribed triamcinolone (Azmacort) metered-dose inhaler (MDI) two puffs every 8 hours and pirbuterol (Maxair) MDI 2 puffs four times a day for a patient with asthma. In teaching the patient about the use of the inhalers, the best instruction by the nurse is a. "Use the Maxair inhaler first, wait a few minutes, then use the Azmacort inhaler." b. "Using a spacer with the MDIs will improve the inhalation of the medications." c. "To avoid side effects, the inhalers should not be used within 1 hour of each other." d. "To maximize the effectiveness of the drugs, inhale quickly when using the inhalers."

b. "Using a spacer with the MDIs will improve the inhalation of the medications."

Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client? a. Hypocapnia b. A hyperinflated chest noted on the chest x-ray c. Increased oxygen saturation with exercise d. A widened diaphragm noted on the chest x-ray

b. A hyperinflated chest noted on the chest x-ray

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 this client? Select all that apply. a. A low arterial PCo2 level b. A hyperinflated chest noted on the chest x-ray c. Decreased oxygen saturation with mild exercise d. A widened diaphragm noted on the chest x-ray e. Pulmonary function tests that demonstrate increased vital capacity

b. A hyperinflated chest noted on the chest x-ray c. Decreased oxygen saturation with mild exercise

A perioperative nurse is caring for a postoperative patient. The patient has a shallow respiratory pattern and is reluctant to cough or to begin mobilizing. The nurse should address the patient's increased risk for what complications? a. Acute respiratory distress syndrome (ARDS) b. Atelectasis c. Aspiration d. Pulmonary embolism

b. Atelectasis

Before weaning a male client from a ventilator, which assessment parameter is most important for the nurse to review? a. Fluid intake for the last 24 hours b. Baseline arterial blood gas (ABG) levels c. Prior outcomes of weaning d. Electrocardiogram (ECG) results

b. Baseline arterial blood gas (ABG) levels

A nurse is assessing a client with chronic airflow limitation and notes that the client has a "barrel chest". The nurse interprets that this client has which of the following forms of chronic airflow limitations? a. Chronic obstructive bronchitis b. Emphysema c. Bronchial asthma d. Bronchial asthma and bronchitis

b. Emphysema

A client states that the physician said the tidal volume is slightly diminished and asks the nurse what this means. The nurse explains that the tidal volume is the amount of air: a. Exhaled forcibly after a normal expiration. b. Exhaled after there is a normal inspiration. c. Trapped in the alveoli that cannot be exhaled. d. Forcibly inspired over and above a normal respiration.

b. Exhaled after there is a normal inspiration.

A nurse is caring for a client who is cyanotic and has a respiratory rate of 8/min with shallow respirations. Which of the following is the priority action by the nurse? a. place a pulse oximeter on the client's finger b. administer oxygen to the client c. establish a patent airway for the client d. check the client's pulse rate

b. administer oxygen to the client

Which of the following individuals would the nurse consider to have the highest priority for receiving an influenza vaccination? A 60-year-old man with a hiatal hernia b. A 36-year-old woman with 3 children c. A 50-year-old woman caring for her spouse with cancer d. A 60-year-old woman with osteoarthritis

c. A 50-year-old woman caring for her spouse with cancer

Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which of the following signs, if noticed in the client, should be reported immediately to the physician? a. Dry cough b. Hematuria c. Bronchospasm d. Blood-streaked sputum

c. Bronchospasm

A nurse is caring for a client 1 day postoperative who has developed atelectasis. Which of the following manifestations is an expected finding for this condition? a. Apnea b. Dysphagia c. Hypoxemia d. Pleural effusion

c. Hypoxemia

A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching? a. Removes the cap and shakes the inhaler well before use. b. Press the canister down with your finger as he breathes in. c. Inhales the mist and quickly exhales. d. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed

c. Inhales the mist and quickly exhales.

The nurse is teaching a client with emphysema about positions that help breathing during dyspneic episodes. The nurse instructs the client to avoid which position, which would aggravate breathing? a. Sitting up and leaning on a table b. Standing and leaning against a wall c. Lying on the back in a low-Fowler's position d. Sitting up with the elbows resting on the knees

c. Lying on the back in a low-Fowler's position

The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of the following s/s would be included in the teaching plan? a. Clubbing of nail beds b. Hypertension c. Peripheral edema d. Increased appetite

c. Peripheral edema

A nurse is caring for a client who is being discharged after having a bronchoscopy. The nurse is discussing which signs or symptoms require the client to contact the provider for after going home. Which of the following signs or symptoms should the client contact the provider about after a bronchoscopy? a. A mild fever that develops in the first 24 hours b. A hoarse voice c. Persistent cough and bloody sputum d. Pain with swallowing

c. Persistent cough and bloody sputum

A patient with a severe exacerbation of COPD requires reliable and precise oxygen delivery. Which mask will the nurse expect the physician to order? a. Non-rebreather air mask b. Tracheostomy collar c. Venturi mask d. Face tent

c. Venturi mask

A nurse is preparing a patient with a pleural effusion for a thoracentesis. The nurse should: a) raise the head of the bed to a high Fowler's position. b) raise the arm on the side of the client's body on which the physician will perform the thoracentesis. c) place the client supine in the bed, which is flat. d) assist the client to a sitting position on the edge of the bed, leaning over the bedside table

d) assist the client to a sitting position on the edge of the bed, leaning over the bedside table

Blessy, a community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is: a. Dyspnea b. Chest pain c. A bloody, productive cough. d. A cough with the expectoration of mucoid sputum.

d. A cough with the expectoration of mucoid sputum.

You are providing care to a patient with a chest tube. On assessment of the drainage system, you note continuous bubbling in the water seal chamber and oscillation. Which of the following is the CORRECT nursing intervention for this type of finding? a. Reposition the patient because the tubing is kinked. b. Continue to monitor the drainage system. c. Increase the suction to the drainage system until the bubbling stops. d. Check the drainage system for an air leak.

d. Check the drainage system for an air leak.

The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection. Which of the following findings would be expected? a. Normal breath sounds b. Prolonged inspiration c. Normal chest movement d. Coarse crackles and rhonchi

d. Coarse crackles and rhonchi

Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? The client will: a. Maintain a fluid intake of 800 mL every 24 hours. b. Experience chills only once a day. c. Cough productively without chest discomfort. d. Experience less nasal obstruction and discharge.

d. Experience less nasal obstruction and discharge.

The most important action the nurse should do before and after suctioning a client is: a. Placing the client in a supine position b. Making sure that suctioning takes only 10-15 seconds c. Evaluating for clear breath sounds d. Hyperventilating the client with 100% oxygen

d. Hyperventilating the client with 100% oxygen

A male patient is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient? a. Activity intolerance related to fatigue b. Anxiety related to actual threat to health status c. Risk for infection related to retained secretions d. Impaired gas exchange related to airflow obstruction

d. Impaired gas exchange related to airflow obstruction

A patient visiting the clinic is diagnosed with acute sinusitis. To promote sinus drainage, the nurse should instruct the patient to perform which of the following? a. Apply a cold pack to the affected area. b. Apply a mustard poultice to the forehead. c. Perform postural drainage. d. Increase fluid intake.

d. Increase fluid intake.