HC3A Exam 1

The nurse assesses a client receiving isoniazid. It is most important for the nurse to observe for which adverse effect? A) Hepatitis B) Glomerulonephritis C) Photosensitivity D) Deafness

A) Hepatitis

Which assessment findings for a community-dwelling client who reports "not feeling well" for about 2 months indicate to the nurse the possibility of active TB? SATA. A) Fatigue B) Weight gain C) Night sweats D) Back soreness E) Persistent cough F) Low-grade fever G) Shortness of breath H) Blood-streaked sputum

A, C, E, F, G, H

A client who has been taking the four first-line drugs for TB treatment for a month reports all of the following changes. Which changes would cause the nurse to collaborate quickly with the health care provider? SATA. A) Blurry vision B) Constipation C) Difficulty sleeping D) Nausea when drinking beer E) Red-tinged urine F) Sunburn with minimal sun exposure G) Yellowing of the sclera

A, G

Which laboratory result for a client with pneumonia will cause the nurse to collaborate quickly with the primary health care provider? A) WBC count of 14,526/mm3 B) PaO2 of 68 mmHg C) PaCO2 of 48 mmHg D) Fasting blood glucose 146 mg/dL

B) PaO2 of 68 mmHg

Which statement by a client with COPD indicates to the nurse a need for additional teaching about the disorder? A) "I have to be careful because I am susceptible to respiratory infections." B) "If the disease becomes more severe, I might develop serious heart failure." C) "My COPD is serious, but it can be reversed if I follow my treatment plan." D) "The lack of oxygen could cause my heart to beat in an irregular pattern."

C) "My COPD is serious, but it can be reversed if I follow my treatment plan."

The nurse cares for a client who expresses apprehension about the diagnosis of terminal lung cancer. The nurse notes the client's blood pressure is 140/88, 92 bpm, 32 respirations/min. The client's ABG values are pH 7.52, PaO2 95 mmHg, PaCO2 30 mmHg, HCO3 24 mEq/L. Which action does the nurse take first? A) Administers oxygen at 2 liters B) Prepares the client for a tracheostomy C) Encourages the client to breathe into a paper bag D) Administers bicarbonate intravenously

C) Encourages the client to breathe into a paper bag

Which mental status change may occur when a client with pneumonia is first experiencing hypoxia? A) Coma B) Apathy C) Irritability D) Depression

C) Irritability

The nurse in the outpatient clinic obtains a client history during the initial visit. The client tells the nurse about recently beginning to take isoniazid daily. The nurse recognizes this medication is used to treat or prevent which problem? A) Hypertension B) Liver failure C) Tuberculosis D) Peripheral neuropathy

C) Tuberculosis

Which action will the nurse take to prevent infection when a 95-year-old nursing home resident has a productive cough, fever, chills, and a history of night sweats but the client's Mantoux test for TB is negative? A) Use Standard Precautions alone because the client does not have TB B) Use Airborne Precautions because the client is at high risk for TB C) Use Airborne Precautions until a chest x-ray shows the client not to have active TB D) Use Standard Precautions alone because the client is taking penicillin therapy for another respiratory infection

C) Use Airborne Precautions until a chest x-ray shows the client not to have active TB

For which possible long-term health changes will the nurse assess a client who has moderate to severe OSA? SATA. A) Anemia B) COPD C) Decreased Cognition D) Diabetes Mellitus E) Resistant Hypertension F) Stroke

C, D, E, F

With which client does the nurse anticipate possible complications from OSA following abdominal surgery? A) 28-year-old who is 80lb overweight and has a short neck B) 48-year-old who has type I diabetes and chronic sinusitis C) 58-year-old who has had gastroesophageal reflux disease for 10 years D) 78-year-old who wears upper and lower dentures and has asthma

A) 28-year-old who is 80lb overweight and has a short neck

A client newly diagnosed with TB is being admitted with prescription for "isolation precautions for TB." The nurse should assign the client to which type of room? A) A room at the end of the hall for privacy B) A private room to implement airborne precautions C) A room near the nurses' station to ensure confidentiality D) A room with windows to allow sunlight

A) A room at the end of the hall for privacy

The nurse is providing follow-up care to a client with TB who does not regularly take the prescribed medication. Which nursing action would be most appropriate for this client? A) Ask the client's spouse to supervise the daily administration of the medications B) Visit the client weekly to verify compliance with taking the medication C) Notify the health care provider of the client's noncompliance, and request a different prescription D) Remind the client that TB can be fatal if is not treated

A) Ask the client's spouse to supervise the daily administration of the medications

Which assessment finding on a client with pneumonia who is receiving IV antibiotics and oxygen by nasal cannula indicates to the nurse that initial goals for this client have been met? A) Client is alert and oriented to person, place, and time B) Blood pressure is within normal limits and the client's baseline C) Skin behind the ears demonstrates no redness or irritation D) Urine output has been >30 mL/hr per foley catheter

A) Client is alert and oriented to person, place, and time

When developing a discharge plan with a client with COPD what information should the nurse include in the plan? People with COPD: A) Develop respiratory infections easily B) Usually maintain their current status C) Require less supplemental oxygen D) Show permanent improvement

A) Develop respiratory infections easily

Which technique for administering the Mantoux test is correct? A) Hold the needle and syringe almost parallel to the client's skin B) Pinch the skin when inserting the needle C) Aspirate before injecting the medication D) Massage the site after injecting the medication

A) Hold the needle and syringe almost parallel to the client's skin

Which route of administration does a nurse use when giving a Mantoux test? A) Intradermal B) SubQ C) Local implantation D) Intramuscular

A) Intradermal

The nurse is planning to teach a client with COPD how to cough effectively. Which instructions should be included? A) Take a deep abdominal breath, bend forward, and cough three or four times on exhalation B) Lie flat on the back, splint the thorax, take two deep breaths, and cough C) Take several rapid, shallow breaths, and then cough forcefully D) Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing

A) Take a deep abdominal breath, bend forward, and cough three or four times on exhalation

To facilitate communication with a client who has a tracheostomy, which nursing approach is best? A) Tell the client to nod the head to indicate "yes," and shake the head to indicate "no" B) Tell the client to mouth the words so the nurse can lip-read C) Have someone who knows the client stay at the bedside to act as an interpreter D) Ask the client to anticipate needs and write them down

A) Tell the client to nod the head to indicate "yes," and shake the head to indicate "no"

Which factors or conditions that increase the risk for development of COPD will the nurse include in preparing client education materials? SATA. A) Alpha1-antitrypsin (AAT) deficiency B) Chronic exposure to inhalation irritants C) Cigarette smoking D) History of asthma E) Mutations in the CFTR gene F) Pulmonary protease deficiency

A, B, C, D

Which assessment findings does the nurse expect to see in a client having an acute asthma attack? SATA. A) Audible wheezing B) Breathlessness while speaking C) Clubbing of the fingers D) Cyanosis of the nail beds E) Use of pursed-lip respirations F) Sternal retractions

A, B, D, F

Which clients will the nurse recognize to be at risk for developing pneumonia? SATA. A) 72-year-old with chronic confusion B) 66-year-old with influenza C) 55-year-old with atrial fibrillation who is taking an oral anticoagulant D) 40-year-old being mechanically ventilated and is orally colonized with gram-negative bacteria E) 35-year-old with hyperthyroid disease F) 28-year-old who is extremely malnourished

A, B, D, F

Which characteristics are most commonly associated with asthma? SATA. A) Airway Hyper-responsiveness B) Narrowed Airway Lumen C) Chronic Bronchitis D) Dilated Alveoli E) Excessive Inflammation F) Leukocyte Activation G) Reversible Airway Obstruction H) Bronchiolar Smooth Muscle Constriction

A, B, E, F, G, H

Which signs or symptoms in a client with long-standing COPD indicate to the nurse the possibility of cor pulmonale? SATA A) Dependent edema B) Distended neck veins C) Systemic high blood pressure D) Hypoxemia and acidosis E) Paralysis of airway cilia F) Swollen liver

A, B, F

Which suggestion will the nurse make to a client with asthma who is a runner to prevent an exercise-induced attack? SATA. A) Use your reliever inhaler before starting your run B) Dress in extra clothing during cold weather C) Run on an indoor track during cold weather D) Use pursed-lip breathing during the run E) Exercise early in the morning before the day becomes too warm F) Avoid eating solid foods before starting your run

A, C

Which actions will the nurse suggest to a client to improve mild sleep apnea? SATA. A) Sleeping on the side rather than in a supine position B) Using CPAP every night C) Losing weight to come within 10% of his or her ideal weight D) Using an oral position-fixing device to prevent tongue subluxation E) Consulting with an oral surgeon about removal of wisdom teeth F) Taking an over-the-counter sleep aid to achieve a deeper sleep

A, C, D

The nurse will recognize the differences in common drug therapy for a client who has COPD from that prescribed for clients with asthma? SATA. A) Addition of mucolytics B) Absence of reliever drugs C) Daily use of nebulizer delivery D) Addition of cholinergic antagonists E) Controllers in combinations of three drugs F) Increased use of immunoglobulin E (IgE) antagonists

A, C, E

Which statements about obstructive sleep apnea (OSA) are true? SATA. A) A main feature is hypopnea B) Results from chronic sinusitis C) Associated with frequent nightmares D) Most commonly diagnosed by flexible bronchoscopy E) Causes fragmented nighttime sleep and daytime drowsiness F) Is most common in people who have a longer than average neck length

A, C, E

Which subjective symptoms will the nurse expect a client with obstructive sleep apnea to report or describe? SATA. A) Excessive daytime sleepiness B) Loss of taste sensation C) Excessive production of sputum D) Decreased ability to concentrate E) Irritability F) Heavy snoring

A, D, E, F

A nurse assessing an older adult client with pneumonia notes the client is now confused and the oxygen saturation has dropped since the last assessment 1 hour ago from 90% to 84%. The nurse also notes the respiratory rate has increased from 26-32. What is the nurse's best first action? A) Encourage the client to use the incentive spirometer hourly B) Increase her O2 flow rate by 2 Liters and reassess in 5 minutes C) Increase the flow rate of the IV antibiotic D) Document the changes as the only action

B) Increase her O2 flow rate by 2 Liters and reassess in 5 minutes

In which areas of the US and Canada is the incidence of TB highest? A) Rural farming areas B) Inner-city areas C) Areas where clean water standards are low D) Suburban areas with significant industrial pollution

B) Inner-city areas

Which ABG value indicates to the nurse that a client with asthma demonstrating increased respiratory effort is in the early phase of the attack? A) PaCO2 of 60 mmHg B) PaCO2 of 30 mmHg C) pH of 7.40 D) PaO2 of 86 mmHg

B) PaCO2 of 30 mmHg

Which parameter indicates to the nurse that the medication administered to the client 5 minutes ago for an acute asthma attack is effective? A) SpO2 decreased from 85% to 78% B) Peak expiratory flow increased from 50% to 70% C) The obvious use of accessory muscles during inhalation D) Active bubbling in the humidifier chamber of the oxygen delivery system

B) Peak expiratory flow increased from 50% to 70%

The nurse provides care for a client needing a tracheostomy. The client's adult child asks the nurse, "Why does my parent need a tracheostomy?" The nurse understands which is the primary reason for performing a tracheostomy?" A) Promotes pulmonary function B) Provides an adequate airway for the client C) Prevents respiratory infections D) Decreases respiratory tract secretions

B) Provides an adequate airway for the client

A client is admitted to the hospital with a diagnosis of acute right upper lobe pneumonia. The client has a history of chronic bronchitis. Which symptom does the nurse expect to see? A) Moist, cool skin B) Rust-colored sputum C) Bradycardia D) Decreased respiratory rate

B) Rust-colored sputum

A client with bacterial pneumonia is to be started on IV antibiotics. The nurse should verify that which diagnostic test has been completed before administering the antibiotic? A) Urinalysis B) Sputum culture C) Chest radiograph D) Red blood cell count

B) Sputum culture

A client with TB is taking isoniazid. What should the nurse instruct the client to do to help prevent development of peripheral neuropathies? A) Adhere to a low-cholesterol diet B) Supplement the diet with pyridoxine (Vitamin B6) C) Get extra rest D) Avoid excessive sun exposure

B) Supplement the diet with pyridoxine (Vitamin B6)

The client with TB is to be discharged home with nursing follow-up. Which aspect of nursing care will have the highest priority? A) Offering the client emotional support B) Teaching the client about the disease and its treatment C) Coordinating various agency services D) Assessing the client's environment for sanitation

B) Teaching the client about the disease and its treatment

Which structures are the most critical to keep patent for effective gas exchange? SATA. A) Nose B) Larynx C) Trachea D) Oropharynx E) Laryngopharynx F) Maxillary Sinuses

B, C, D

Which changes in signs and symptoms in a client with bacterial pneumonia does the nurse report to the primary health care provider as indicators of possible empyema? SATA. A) Increased production of thick yellow sputum B) Reduced chest wall motion on one side C) Decreased breath sounds D) Flat percussion E) Persistent fever F) Wheezing

B, C, D, E

Which common features of COPD does the nurse recognize as increasing a client's risk for respiratory infection? SATA. A) Acidosis B) Ineffective cough C) Poor ciliary function D) Inadequate nutrition E) Excessive thick mucous F) Right-sided heart failure

B, C, D, E

Which information is most relevant for the nurse to teach a client about CPAP therapy for OSA? SATA. A) Avoid alcoholic beverages or drugs that make you sleepy within 3 hours of bed time B) Clean the mask device daily C) Ensure your mask devices fits tightly enough to prevent air leaks D) Keep open flames such as candles out of the room when CPAP is in use E) Seal the mask edges to your face petroleum jelly F) Use only sterile water in the humidifier tank G) Use the CPAP during all sleep periods, especially in bed H) Do not share your mask or tubing system with others

B, C, G, H

A client newly diagnosed with COPD is to be discharged home with oxygen per nasal prongs. Which teaching points should the nurse include in this client's discharge plan? SATA. A) Apply petroleum jelly on lips and nose to prevent dryness and irritation B) Avoid areas where people are smoking cigarettes or cigars C) Increase oxygen flow rate at night during hours of sleep D) Place gauze between the ears and oxygen tubing to prevent skin irritation E) Request a large, pressurized oxygen tank for use during car travel F) Avoid use of a microwave oven when using oxygen

B, D

The nurse is teaching a client who has been diagnosed with TB how to avoid spreading the disease to family members. Which statements indicate that the client has understood the nurse's instructions? SATA. A) "I will need to dispose of my old clothing when I return home." B) "I should always cover my mouth and nose when sneezing." C) "It is important that I isolate myself from family when possible." D) "I should use paper tissues to cough in and dispose of them properly." E) "I will avoid crowds."

B, D

A client diagnosed with TB has been placed on drug therapy. The medication regimen includes rifampin. Which instruction should the nurse give the client about the potential adverse effects of rifampin? SATA. A) Have eye examinations every 6 months B) Maintain follow-up monitoring of liver enzymes C) Decrease protein intake in the diet D) Avoid alcohol intake E) The urine may have an orange color

B, D, E

Which clients will the nurse recognize as at higher risk for having active TB in North America? SATA. A) 22-year-old college student sharing a room in a dormitory B) 28-year-old man with HIV-III (AIDS) C) 48-year-old homemaker who volunteers at a soup kitchen D) 55-year-old homeless man with alcoholism who stays weekly in a shelter E) 60-year-old migrant farm worker from Mexico F) 68-year-old man incarcerated for 20 years

B, D, E, F

Which additional client condition(s) or factor(s) will the nurse recognize as increasing the risk for ventilatory-associated pneumonia (VAP)? SATA A) History of alcohol use and cigarette smoking B) Presence of feeding tube C) Unplanned weight loss D) IV therapy with normal saline E) Tooth loss and mouth sores F) Bacterial colonization of the airway

B, E, F

The nurse instructs a client about how to use an incentive spirometer. The nurse determines the teaching is effective if the client makes which statement? A) "I should take a deep breath and blow into the mouthpiece." B) "I'm glad that I only have to do this twice a day." C) "I can ask for pain medication prior to using the spirometer." D) "I should lie down to use the incentive spirometer."

C) "I can ask for pain medication prior to using the spirometer."

A nursing home client who has completed a 2-week course of antibiotics for bacterial pneumonia asks whether he can go out to a restaurant to celebrate his grandson's high school graduation if he uses a wheelchair. What is the nurse's best response? A) "No, going out now before you have recovered your strength can cause a relapse of the pneumonia." B) "No, the risk that you could spread this disease to other people is much too high." C) "Yes if you want to, and feel that you could tolerate a couple of hours of sitting." D) "Yes, if you agree to wear a face mask to prevent spreading droplets."

C) "Yes if you want to, and feel that you could tolerate a couple of hours of sitting."

What is the best explanation a nurse will provide to a client whose skin test for TB is positive? A) "There is an active disease, but you are not infectious yet." B) "There is an active disease, and you need to start drug therapy immediately." C) "You have been infected, but this does not mean active disease is present." D) "A repeat skin test is necessary because the test could give a false-positive result."

C) "You have been infected, but this does not mean active disease is present."

A client is prescribed rifampin and isoniazid. Which explanation concerning these medications is most appropriate for the nurse to give the client? A) "You will have to take these medications for the rest of your life." B) "You must isolate yourself from your family while on these medications." C) "You will have to take these medications for 6 to 9 months." D) "You will need to take these medications only when you have symptoms."

C) "You will have to take these medications for 6 to 9 months."

With which client who has COPD does the nurse suspect that chronic bronchitis is more of a problem than emphysema? A) 52-year-old with an alpha1-antitrypsin (AAT) deficiency B) 60-year-old with a 60 pack-year cigarette smoking history C) 66-year-old with chronic hypoxia, PaCO2 of 40 mmHg, and cyanosis D) 70-year-old with PaCO2 of 65 mmHg, dependent edema, and SpO2 of 93%

C) 66-year-old with chronic hypoxia, PaCO2 of 40 mmHg, and cyanosis

The nurse is caring for a client with bacterial pneumonia. The effectiveness of the client's oxygen therapy can be best determined by which indicator of oxygenation? A) Absence of cyanosis B) Client's respiratory rate C) Arterial blood gas values (ABG) D) Client's level of consciousness

C) Arterial blood gas values (ABG)

A client requires an emergency tracheostomy. When caring for the tracheostomy, the nurse takes which action? A) Suctions the tracheostomy every hour B) Cleans the inner cannula after suctioning C) Cleans the site every 4 hours D) Hyperextends the neck to maintain patency

C) Cleans the site every 4 hours

When performing a medication reconciliation for a newly admitted client before planned abdominal surgery, the nurse notes that the client is prescribed Salmeterol and Fluticasone daily for asthma control. What is the priority action for the nurse to take regarding this information to prevent harm? A) Record and display the information in a prominent place within the client's medical record B) Ask the client how long the drugs have been prescribed and how well the asthma is controlled C) Collaborate with the surgeon to arrange for continuation of this therapy in the peri-operative period D) Ensure that parenteral forms of these drugs are prescribed for use while the client remains NPO after surgery

C) Collaborate with the surgeon to arrange for continuation of this therapy in the peri-operative period

The nurse is instructing a sexually active female who is taking isoniazid. What should the nurse tell the client? Isoniazid: A) Increases the risk of vaginal infection B) Has mutagenic effects on ova C) Decreases the effectiveness of hormonal contraceptives D) Inhibits ovulation

C) Decreases the effectiveness of hormonal contraceptives

Which precaution related to noninvasive positive pressure ventilation (NPPV) by CPAP is most important for the nurse to teach to a client with OSA who is being managed by CPAP? A) Use the CPAP machine only for the first 2 hours of sleep B) Avoid using the CPAP equipment when you have a respiratory infection C) Ensure the mask or nasal pillows fits tightly over your nose and/or mouth D) Ensure that there are no open flames (fireplace or candles) in the room when CPAP is in use

C) Ensure the mask or nasal pillows fits tightly over your nose and/or mouth

A client is receiving streptomycin to treat TB. What should the nurse evaluate to determine an adverse effect of the drug? A) Decreased serum creatinine B) Difficulty swallowing C) Hearing loss D) IV infiltration

C) Hearing loss

The nurse is assessing a client with COPD. Which finding requires immediate intervention? A) Distant heart sounds B) Diminished lung sounds C) Inability to speak D) Pursed-lip breathing

C) Inability to speak

A client diagnosed with COPD is drowsy and unable to expectorate secretions. The nurse takes which initial action? A) Forces fluids B) Administers high-flow oxygen via mask C) Performs nasotracheal suctioning D) Encourages the client to pursed-lip breathe

C) Performs nasotracheal suctioning

Clients who have had active TB are at risk for recurrence. Which condition increases that risk? A) Cool and damp weather B) Active exercise and exertion C) Physical and emotional stress D) Rest and inactivity

C) Physical and emotional stress

Which priority action will the nurse take to help prevent the complication of pneumonia for a client who is postoperative from extensive abdominal surgery? A) Monitoring chest x-rays and WBC counts for early signs of infection B) Monitoring lung sounds every shift and encouraging fluids C) Teaching coughing, deep-breathing exercises, and use of incentive spirometry D) Encouraging hand hygiene among all caregivers, clients, and visitors

C) Teaching coughing, deep-breathing exercises, and use of incentive spirometry

Which factor will the nurse recognize as increasing a client's risk for developing community acquired pneumonia (CAP)? A) Obtaining an influenza vaccination in November rather than September B) Having received a pneumococcal vaccination C) Using tobacco and alcohol often and regularly D) Living alone and preparing own meals

C) Using tobacco and alcohol often and regularly

With which clients will the nurse be alert for an increased risk of OSA? SATA. A) 26-year-old woman who had tonsils and adenoids removed as a child B) 35-year-old man who is a marathon runner C) 48-year-old woman who has a short neck and a small chin D) 56-year-old man who smokes two packs of cigarettes daily E) 65-year-old man who is malnourished and has COPD F) 80-year-old woman who is cognitively impaired from Alzheimer disease

C, D

Which information should the nurse include in a teaching plan for the client newly diagnosed with COPD? SATA. A) Pulmonary rehabilitation programs offer very little benefit B) Pneumococcal vaccination is contraindicated for clients with lung disease C) High humidity increases the effort of breathing D) A bronchodilator with metered-dose inhaler should be readily available E) Smoking cessation is important to slow or stop progression of disease

C, D, E

Which client assessment findings alert the nurse to the possibility of uncomplicated community-acquired pneumonia? SATA. A) Abdominal pain B) Back pain C) Chest discomfort D) Dyspnea E) Increased sputum production F) Fever

C, D, E, F

Which statement(s) regarding drug therapy for asthma is(are) true? SATA. A) A nursing priority for clients prescribed interleukin-5 antagonists is teaching them the correct subcutaneous technique for self-injection B) Increases in a client's forced expiratory volume in the first second (FEV1) is a positive indicator for asthma diagnosis C) Inhaled anti-inflammatory drugs are always used for asthma control and never acute asthma rescue D) Reliever drugs are delivered by inhaler and controller drugs are taken orally E) Metered dose inhalers are most effective with the use of a spacer F) Oxygen is considered a type of asthma control drug G) Daily magnesium sulfate prevents asthma attacks

C, E

Which client with asthma does the nurse consider to have the highest risk for a fatal outcome of an acute attack? A) 24-year-old with exercise-induced wheezing B) 45-year-old recovering from pneumonia C) 58-year-old who has Type II Diabetes Mellitus D) 76-year-old with hypertension

D) 76-year-old with hypertension

When instructing clients on how to decrease the risk of chronic obstructive pulmonary disease (COPD), the nurse should emphasize which instruction? A) Participate regularly in aerobic exercises B) Maintain a high-protein diet C) Avoid exposure to people with known respiratory infections D) Abstain from cigarette smoking

D) Abstain from cigarette smoking

Which statement indicates that the client with COPD who has been discharged to home understands the care plan? The client: A) Plans to avoid direct contact with family and friends B) Can state actions to reduce pain C) Will use oxygen via a nasal cannula at 5 L/min D) Agrees to call the health care provider if dyspnea on exertion increases

D) Agrees to call the health care provider if dyspnea on exertion increases

The nurse is instructing the client with COPD to do pursed-lip breathing. What is the expected outcome of this exercise? A) Improved oxygen intake B) Deeper diaphragmatic breathing C) Stronger intercostal muscles D) Better elimination of carbon dioxide

D) Better elimination of carbon dioxide

The nurse is assessing the respiratory status of a client who is experiencing an exacerbation of COPD secondary to upper respiratory tract infection. Which finding is expected? A) Normal breath sounds B) Prolonged inspiration C) Normal chest movement D) Coarse crackles and rhonchi

D) Coarse crackles and rhonchi

The nurse provides care for a client with a new tracheostomy postoperatively. It is most important for the nurse to take which action? A) Place the client supine until vital signs are stable B) Ask the client which position makes them the most comfortable C) Place the client with the head elevated and neck hyperextended D) Elevate the client's head and turn head to one side until consciousness returns

D) Elevate the client's head and turn head to one side until consciousness returns

Which diet would be most appropriate for a client with COPD? A) Low-fat, low-cholesterol diet B) Bland, soft diet C) Low-sodium diet D) High-calorie, high-protein diet

D) High-calorie, high-protein diet

When making rounds, the nurse observes that a cognitively impaired clients has a partial airway obstruction from inspissation. What is the nurse's priority action? A) Place the bed in reverse Trendelenburg position and apply humidified oxygen by nasal cannula B) Check the flow sheet to assess for trends in the client's oxygen saturation patterns C) Determines which assistive personnel provided this client's morning care today D) Immediately provide complete oral care to this client

D) Immediately provide complete oral care to this client

The client reports sleepiness, nausea, and vomiting. The nurse notes the client is confused and respirations are deep and labored with a respiratory rate of 32 breaths/min. The ABG values are PaCO2 30 mmHg, pH 7.30, and HCO3 20 mEq/L. Which action does the nurse take? A) Starts an infusion of 5% dextrose and water as per standing orders and contacts health care provider B) Places a paper bag over the client's mouth and nose to re-breathe expired air C) Gives morphine intravenously to relieve the client's pain D) Place the client in Fowler's position and encourage measures to support hyperventilation

D) Place the client in Fowler's position and encourage measures to support hyperventilation

Which non-pulmonary change in a client with COPD indicates to the nurse that the disorder may be becoming more serious? A) Abdominal muscles contract on exhalation B) Increased urinary output at night C) Morning sputum production D) Weight loss of 11 lb (5 kg)

D) Weight loss of 11 lb (5 kg)

Which asthma drugs or drug categories have the primary purpose of asthma relief (rescue) rather than asthma control? SATA. A) Anti-inflammatories B) Cholinergic antagonists C) IgE antagonists D) Interleukin antagonists E) Long-acting beta-agonists F) Short-acting beta-agonists

F) Short-acting beta agonists

Which 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

Which chest x-ray finding will the nurse expect to see for a client suspected to have pneumonia? A) Patchy areas of increased density B) "Ground-glass" appearance of the lung C) Mediastinal widening D) Large hyper-inflated airways

A) Patchy areas of increased density

The client's ABGs are pH 7.49, PaCO2 37 mmHg, PaO2 96 mmHg, SaO2 98%, HCO3- 24 mEq/L, and potassium 4.2 mEq/L. The nurse understands the blood gases suggest the client is experiencing which condition? A) Respiratory Alkalosis B) Metabolic Acidosis C) Respiratory Acidosis D) Metabolic Alkalosis

A) Respiratory Alkalosis

The nurse observes a student nurse perform tracheostomy care to a client. The nurse determines care is appropriate if the student nurse places the client in which position? A) Semi-Fowler B) Supine C) Prone D) Trendelenburg

A) Semi-Fowler

The nurse suctions a client's tracheostomy. The nurse lubricates the catheter with which material? A) Sterile water B) Mineral oil C) Hydrogen peroxide D) Water-soluble lubricant

A) Sterile water

Which symptom in a client with COPD does the nurse associate directly with chronic hypoxemia? A) Finger clubbing B) Barrel chest C) Pursed-lip breathing D) Increased mucous production

A) Finger clubbing

What is the nurse's best response to a client with COPD who states that there is no reason to quit cigarette smoking now that the disease has already been diagnosed? A) "If you stop smoking now, the damage to your lungs can be reversed." B) "Smoking cessation can slow the rate of your disease progression." C) "You are correct, nothing will change the course of your disease now." D) "You can serve as a role model to others by quitting smoking."

B) "Smoking cessation can slow the rate of your disease progression."

For a client with asthma, the health care provider prescribes albuterol, two puffs twice a day via metered-dose inhaler, and beclomethasone, two puffs twice a day via MDI. How should the nurse instruct the client to administer these drugs? A) "Take the medications 1 hour apart, two times a day." B) "Take the albuterol first and follow with beclomethasone two times a day." C) "Take the albuterol on awakening and alternate the medications every 4 hours." D) "Take the beclomethasone inhaler first and follow with albuterol."

B) "Take the albuterol first and follow with beclomethasone two times a day."

The nurse identifies which client is at most risk for developing pneumonia? A) A client with an indwelling catheter B) A client with an NG tube C) A client diagnosed with psoriasis D) A client diagnosed with Paget disease

B) A client with an NG tube

The nurse reviews an ABG report for a client with COPD. The results are as follows: pH 7.35, PCO2 62, PaO2 70, and HCO3 34. What should the nurse do first? A) Apply a 100% nonrebreather mask B) Assess the vital signs C) Reposition client D) Prepare for intubation

B) Assess the vital signs

A client has a positive reaction to the Mantoux test. How should the nurse interpret this reaction? The client has: A) Active TB B) Been exposed to Mycobacterium tuberculosis C) Developed a resistance to tubercle bacilli D) Developed passive immunity to TB

B) Been exposed to Mycobacterium tuberculosis

When teaching a client with COPD to conserve energy, what instruction should the nurse give the client about breathing when lifting heavy objects? Lift the object by: A) Inhaling through an open mouth B) Exhaling through pursed lips C) Exhaling but before inhaling D) Taking a deep breath and holding it

B) Exhaling through pursed lips

A client with COPD is experiencing dyspnea and has a low PaO2 level. The nurse plans to administer oxygen as prescribed. Which statement is true concerning oxygen administration to a client with COPD? A) High oxygen concentrations will cause coughing and dyspnea B) High oxygen concentrations may inhibit the hypoxic stimulus to breathe C) Increased oxygen will cause the client to become dependent on the oxygen D) Administration of oxygen is contraindicated in clients who are using bronchodilators

B) High oxygen concentrations may inhibit the hypoxic stimulus to breathe

The nurse understands which is the cause of respiratory alkalosis? A) Hyperglycemia B) Hyperventilation C) Fluid loss D) Airway compromise

B) Hyperventilation

Which assessment finding for a client who received the subcutaneous Mantoux skin test 72 hours ago will the nurse interpret as a positive test result for TB? A) Test area is red, warm, and blistered B) A flat, erythematous skin rash is present at the test site C) Induration/hardened area measures 5mm or greater D) Induration/hardened area measures 10mm or greater

D) Induration/hardened area measures 10mm or greater

What is the nurse's best response to a client with COPD who is prescribed an inhaled long-acting beta2 agonist and asks why the drug can't be taken as a pill? A) "Drugs taken by inhaler work more slowly and remain in the system longer." B) "Drugs taken by inhaler have no side effects and are less expensive." C) "Drugs taken by mouth are more expensive because they must be sterile." D) "Drugs taken by mouth have systemic effects and are harder to control."

D) "Drugs taken by mouth have systemic effects and are harder to control."

The nurse provides care for a client with active tuberculosis. Which instructions does the nurse give the client about follow-up care after discharge from the hospital? A) "We would like you to come to the clinic monthly to recheck your tine test and look for changes in your chest x-ray." B) "We would like you to return to the clinic only if you experience any adverse effects from the medications." C) "We would like you to come to the clinic weekly for your isoniazid injections." D) "We would like you to come to the clinic monthly to check the effects of the medication you are taking."

D) "We would like you to come to the clinic monthly to check the effects of the medication you are taking."

Which family member exposed to TB would be at highest risk for contracting the disease? A) 45-year-old mother B) 17-year-old daughter C) 8-year-old son D) 76-year-old grandmother

D) 76-year-old grandmother

The nurse teaches a client diagnosed with tuberculosis. The nurse explains which is the cause for TB? A) A virus B) Poor sanitation C) Poor nutrition D) A bacterium

D) A bacterium

Which nursing action would be most likely successful in reducing pleuritic chest pain in a client with pneumonia? A) Encourage client to breathe shallowly B) Have the client practice abdominal breathing C) Offer the client incentive spirometry D) Teach the client to splint the rib cage when coughing

D) Teach the client to splint the rib cage when coughing

For which client with pneumonia and hypoxemia will the nurse avoid the use of oxygen therapy? SATA. A) 28-year-old with community-acquired pneumonia B) 38-year-old with fractured ribs C) 48-year-old with type II diabetes D) 58-year-old with metastatic breast cancer E) 68-year-old with COPD F) 78-year-old with acute confusion G) None of the above

G) None of the above

Which specific signs and symptoms does the nurse expect to see in an 80-year-old client admitted with bacterial pneumonia? SATA. A) Confusion B) Decreased oxygen saturation C) Productive cough D) Weakness and fatigue E) Elevated WBC count F) Fever

A, B, D