Level 3 exam 3
A patient with TB has been admitted to the hospital and is placed in an air borne infection isolation room.What should the patient be taught?
-take all meds for full length to prevent multi resistant TB - wear a standard isolation mask if leaving the airborne infection isolation room - maintain precautions in air borne infection isolation room by coughing into napkins
pathophysiologic stages of pneumonia in order
1- inflammatory response in the lungs with neutrophils is activated to engulf and kill the off ending organism 2- increased capillary permeability contributes to alveolar filling with organisms and neutrophils interrupt normal oxygen transportation 3- mucus production increases and can obstruct airflow and further decrease gas exchange 4- macrophages lyse the debris and normal lung tissue and function is restored
1. A patient with asthma has a personal best PEFR of 400 L/min. When explaining the asthma action plan, the nurse will teach the patient that a change in therapy is needed when the PEFR is less than ___ L/minute
320
1. After assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis? a. Weak cough effort b. Profuse green sputum c. Respiratory rate of 28 breaths/minute d. Resting pulse oximetry (SpO2) of 85%
A
14. A patient with acute dyspnea is scheduled for a CT scan. Which information obtained by the nurse is a priority to communicate to the health care provider before the CT? a. Allergy to shellfish c. Respiratory rate of 30 b. Apical pulse of 104 d. O2 saturation of 90%
A
14. Employee health test results reveal a TB skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB. Which information should the occupational health nurse plan to teach the staff nurse? a. Use and side effects of isoniazid b. Standard four-drug therapy for TB c. Need for annual repeat TB skin testing d. Bacille Calmette-Guérin (BCG) vaccine
A
15. Which patient in the ear, nose, and throat (ENT) clinic should the nurse assess first? a. A patient who is complaining of a sore throat and has a muffled voice b. A patient who has a "scratchy throat" and a positive rapid strep antigen test c. A patient who is receiving radiation for throat cancer and has severe fatigue d. A patient with a history of a total laryngectomy whose stoma is red and inflamed
A
20. The nurse assesses a patient with (COPD) who has been admitted with increasing dyspnea over the past 3 days. Which finding is important for the nurse to report to the health care provider? a. RR are 36 breaths/min. b. Anterior-posterior chest ratio is 1:1. c. Lung expansion is decreased bilaterally . d. Hyperresonance to percussion is present.
A
26. The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment could be used to evaluate the effectiveness of the therapies? a. Observe for distended neck veins. b. Auscultate for crackles in the lungs. c. Palpate for heaves or thrills over the heart. d. Monitor for elevated white blood cell count.
A
31. The nurse is caring for a patient who has just had a thoracentesis. Which assessment information obtained by the nurse is a priority to communicate to the health care provider? a. O2 saturation is 88%. b. Blood pressure is 155/90 mm Hg c. Pain level is 5 with a deep breath d. RR is 24 bpm when lying flat.
A
38. The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with COPD. The results for which patient will require the most rapid action by the nurse? a. pH 7.28, PaCO2 50 mm Hg, and PaO2 58 mm Hg b. pH 7.48, PaCO2 30 mm Hg, and PaO2 65 mm Hg c. pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg d. pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg
A
39. Which nursing action for a patient with COPD could the nurse delegate to UAP? a. Obtain O2 saturation using pulse oximetry. b. Monitor for increased O2 need with exercise. c. Teach the patient about safe use of O2 at home. d. Adjust O2 to keep saturation in prescribed parameters.
A
42. A patient who was admitted the previous day with pneumonia complains of a sharp pain of 7 "whenever I take a deep breath." Which action will the nurse take next? a. Auscultate for breath sounds. b. Administer the PRN morphine. c. Have the patient cough forcefully. d. Notify the patient's health care provider.
A
44. After change-of-shift report, which patient should the nurse assess first? a. Patient with a urethral stricture who has not voided for 12 hours b. Patient who has cloudy urine after orthotopic bladder reconstruction c. Patient with polycystic kidney disease whose blood pressure is 186/98 mm Hg d. Patient who voided bright red urine immediately after returning from lithotripsy
A
8. A young adult patient who denies any history of smoking is seen in the clinic with a new diagnosis of COPD. The nurse should plan to teach the patient about a. 1-antitrypsin testing. c. use of the nicotine patch. b. leukotriene modifiers. d. continuous pulse oximetry.
A
A patient who is lethargic and exhibits deep, rapid respirations has the following arterial blood gas (ABG) results: pH 7.32, PaO2 88 mm Hg, PaCO2 37 mm Hg, and HCO3 16 mEq/L. How should the nurse interpret these results? a. Metabolic acidosis c. Respiratory acidosis b. Metabolic alkalosis d. Respiratory alkalosis
A
An older adult with HIVwho takes medications for coronary artery disease and hypertension has chosen to begin ART. Which information will the nurse include in patient teaching? a. Many drugs interact with antiretroviral medications. b. HIV progress more rapidly in older adults. c. Less frequent CD4+level monitoring is needed in older adults. d. Hospice care is available for patients with terminal HIV
A
Eight years after seroconversion, a HIV patient has a CD4+ ofv800/µL and an undetectable viral load. What is the priority nursing intervention at this time? a. Encourage adequate nutrition, exercise, and sleep. b. Teach about the side effects of antiretroviral agents. c. Explain opportunistic infections and antibiotic prophylaxis. d. Monitor symptoms of AIDS
A
The mechanism of action for morphine is A) Works on opioid receptors in the brain B) Targets the area of pain to increase blood flow C) Blocks feelings of pain and decreasing overall sensation
A
The nurse is advising a clinic patient who was exposed a week ago to HIV through unprotected sexual intercourse. The patient's antigen and antibody test has just been reported as negative for HIV. What instructions should the nurse give to this patient? a. "You will need to be retested in 2 weeks." b. "You do not need to fear infecting others." c. "Since you don't have symptoms and you have had a negative test, you do not have HIV)." d. "We won't know for years if you will develop AIDS"
A
The nurse is treating the depressed respiratory rate. What is the first action the nurse should take? A) Stop the PCA and move the PCA button. B) Go to the pyxis for the medication C).Call the HCP for orders. D) Raise the head of the bed.
A
To evaluate the effectiveness of ART, which laboratory test result will the nurse review? a. Viral load testing c. Rapid HIV antibody testing b. Enzyme immunoassay d. Immunofluorescence assay
A
11. An older patient is receiving standard multidrug therapy for TB. The nurse should notify the health care provider if the patient exhibits which finding? a. Yellow-tinged sclera b. Orange-colored sputum c. Thickening of the fingernails d. Difficulty hearing high-pitched voices
A .
17. Which information about prevention of lung disease should the nurse include for a patient with a 42 pack-year history of cigarette smoking? a. Resources for support in smoking cessation b. Reasons for annual sputum cytology testing c. Erlotinib (Tarceva) therapy to prevent tumor risk d. CT screening for cancer
A .
2. The nurse assesses the chest of a patient with pneumococcal pneumonia. Which finding would the nurse expect? a. Increased tactile fremitus c. Hyperresonance to percussion b. Dry, nonproductive cough d. A grating sound on auscultation
A .
4. On auscultation of a patient's lungs, the nurse hears low-pitched, bubbling sounds during inhalation in the lower third of both lungs. How should the nurse document this finding? a. Inspiratory crackles at the bases b. Expiratory wheezes in both lungs c. Abnormal lung sounds in the apices of both lungs d. Pleural friction rub in the right and left lower lobes
A .
The nurse is caring for a patient with (HIV) who has just been diagnosed with asymptomatic chronic HIV infection. Which prophylactic measures will the nurse include in the plan of care (SATA)? a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine d. Trimethoprim-sulfamethoxazole e. Varicella zoster immune globulin
A, B, C
1. Which factors will the nurse consider when calculating the CURB-65 score for a patient with pneumonia (SATA)? a. Age d. O2 saturation b. Blood pressure e. Presence of confusion c. Respiratory rate f. BUN level
A, B, C, E, F
When administering morphine through a patient-controlled analgesic (PCA) pump. The nurse should evaluate which of these? (SATA) A) IV patency B) Neurological status C) Peripheral pulses D) Deep tendon reflexes E) Pain level
A, B, E
The nurse plans a presentation for community members about how to decrease the risk for antibiotic-resistant infections. Which information will the nurse include in the teaching plan (SATA)? a. Antibiotics may sometimes be prescribed to prevent infection. b. Continue taking antibiotics until all of the prescription is gone. c. Unused antibiotics that are more than a year old should be discarded. d. Antibiotics are effective in treating influenza associated with high fevers. e. Hand washing is effective in preventing many viral and bacterial infections. .
A, B, E .
Based on potential complications associated with morphine, which client(s) should not be prescribed morphine? (SATA) A) A client who have suffered a head injury. B) A client who has kidney stones C) .A client who is dehydrated. D) A client who is allergic to penicillin E) .A client experiencing severe abdominal pain.
A, C
. A patient is concerned that he may have asthma. Of the symptoms that he relates to the nurse, which one suggest asthma or risk factors for asthma? select alla. allergic rhinitisb. prolonged inhalationc.history of skin allergiesd. cough, especially at nighte. gastric reflux or heart burn
A, C, D, E
5. A student asks the RN what can be measured by arterial blood gases. The RN tells the student that the ABGs can measure (select all)a. acid-base balanceb. oxygenation statusc. acidity of the bloodd. glucose bound to hemaglobine. bicarb in arterial blood
A,B,C,E
1. A patient is scheduled for CT scan of the chest with contrast media. Which assessment findings should the nurse report to the health care provider before the patient goes for the CT (SATA)? a. Allergy to shellfish b. Patient reports claustrophobia c. Elevated serum creatinine level d. Recent bronchodilator inhaler use e. Inability to remove a wedding band
A,C
)At change of shift, your are giving bedside report to the oncoming nurse and checking the PCA. Luis appears to be resting comfortably, with a respiratory rate of 16 breaths/minute. In checking the PCA you find that in the last 4 hours he has attempted to get pain medication 5 times and has received it all 5 times. What does this indicate to the nurse? A) Luis needs less pain medication. B)Luis seems to be receiving adequate pain control. C) Luis will need supplemental pain medication.
B
1. A 46-yr-old female patient returns to the clinic with recurrent dysuria after being treated with trimethoprim and sulfamethoxazole for 3 days. Which action will the nurse plan to take? a. Remind the patient about the need to drink 1000 mL of fluids daily. b. Obtain a midstream urine specimen for culture and sensitivity testing. c. Suggest that the patient use acetaminophen to relieve symptoms. d. Teach the patient to take the prescribed trimethoprim and sulfamethoxazole for 3 more days.
B
1. The nurse teaches a patient with chronic bronchitis about a new prescription for Advair Diskus (combined fluticasone and salmeterol). Which action by the patient would indicate to the nurse that teaching about medication administration has been successful? a. The patient shakes the device before use . b. The patient rapidly inhales the medication. c. The patient attaches a spacer to the Diskus. d. The patient performs huff coughing after inhalation.
B
10. The nurse observes a student who is listening to a patient's lungs. Which action by the student indicates a need to review respiratory assessment skills? a. The student compares breath sounds from side to side at each level. b. The student listens during the inspiratory phase, then moves the stethoscope. c. The student starts at the apices of the lungs, moving down toward the lung bases. d. The student instructs the patient to breathe slowly and deeply through the mouth.
B
12. A patient admitted to the emergency department complaining of sudden onset shortness of breath is diagnosed with a possible pulmonary embolus. How should the nurse prepare the patient for diagnostic testing to confirm the diagnosis? a. Ensure that the patient has been NPO. b. Start an IV so contrast media may be given. c. Inform radiology that radioactive glucose preparation is needed. d. Instruct the patient to expect to inspire deeply and exhale forcefully.
B
12. Which action should the nurse take first when a patient develops epistaxis? a. Pack the affected nare tightly with an epistaxis balloon. b. Apply squeezing pressure to the nostrils for 10 minutes. c. Obtain silver nitrate that may be needed for cauterization. d. Instill a vasoconstrictor medication into the affected nare.
B
13. The nurse teaches a patient about pursed-lip breathing. Which action by the patient would indicate to the nurse that further teaching is needed? a. The patient inhales slowly through the nose . b. The patient puffs up the cheeks while exhaling . c. The patient practices by blowing through a straw. d. The patient's ratio of inhalation to exhalation is 1:3.
B
14. Which finding by the nurse for a patient with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment? a. Even, unlabored respirations c. Absence of wheezes or crackles b. Pulse oximetry reading of 92% d. Respiratory rate of 18 breaths/min
B
15. The nurse supervises a student nurse who is assigned to take care of a patient with TB. Which action, if performed by the student nurse, would require an intervention by the nurse? a. The patient is offered a tissue from the box at the bedside. b. A surgical face mask is applied before visiting the patient. c. A snack is brought to the patient from the unit refrigerator. d. Hand washing is performed before entering the patient's room.
B
16. The nurse is admitting a patient diagnosed with an acute exacerbation of COPD. How should the nurse determine the appropriate O2 flow rate? a. Minimize O2 use to avoid O2 dependency. b. Maintain the pulse oximetry level at 90% or greater. c. Administer O2 according to the patient's level of dyspnea. d. Avoid administration of O2 at a rate of more than 2 L/min.
B
16. The nurse obtains the following assessment data on an older patient who has influenza. Which information will be most important for the nurse to communicate to the health care provider? a. Fever of 100.4° F b. Diffuse crackles in the lungs c. Sore throat and frequent cough d. Myalgia and persistent headache
B
18. A patient is receiving 35% O2 via a Venturi mask. To ensure the correct amount of O2 delivery, which action by the nurse is important? a. Teach the patient to keep the mask on during meals. b. Keep the air entrainment ports clean and unobstructed . c. Give a high enough flow rate to keep the bag from collapsing. d. Drain moisture condensation from the corrugated tubing every hour.
B
22. A patient with COPD has poor gas exchange. Which action by the nurse would support the patient's ventilation? a. Have the patient rest in bed with the head elevated to 15 to 20 degrees. b. Encourage the patient to sit up at the bedside in a chair and lean forward . c. Ask the patient to rest in bed in a high-Fowler's position with the knees flexed. d. Place the patient in the Trendelenburg position with pillows behind the head.
B
22. Which action is appropriate for the nurse to delegate to UAP? a. Listen to a patient's lung sounds for wheezes or . b. Label specimens obtained during percutaneous lung biopsy . c. Instruct a patient about how to use home spirometry testing. d. Measure induration at the site of a patient's intradermal skin test.
B
27. A patient with COPD has coarse crackles throughout the lung fields and a chronic, nonproductive cough. Which nursing intervention will be most effective? a. Change the O2 flow rate to the highest prescribed rate . b. Teach the patient to use the Flutter airway clearance device. c. Reinforce the ongoing use of pursed-lip breathing techniques. d. Teach the patient about consistent use of inhaled corticosteroids.
B
28. The nurse provides dietary teaching for a patient with COPD who has a low BMI. Which patient statement indicates that the teaching has been effective? a. "I will drink lots of fluids with my meals." b. "I can have ice cream as a snack every day." c. "I will exercise for 15 minutes before meals." d. "I will decrease my intake of meat and poultry."
B
30. A patient has just been admitted with probable bacterial pneumonia and sepsis. Which order should the nurse implement first? a. Chest x-ray via stretcher b. Blood cultures from two sites c. Ciprofloxacin (Cipro) 400 mg IV d. Acetaminophen rectal suppository
B
39. A patient seen in the clinic for a bladder infection describes the following symptoms. Which information is most important for the nurse to report to the health care provider? a. Urinary urgency c. Intermittent hematuria b. Left-sided flank pain d. Burning with urination
B
42. The nurse receives a change-of-shift report on the following patients with COPD. Which patient should the nurse assess first? a. A patient with loud expiratory wheezes b. A patient with a RR of 38 bpm c. A patient who has a cough productive of thick, green mucus d. A patient with jugular venous distention and peripheral edema
B
5. Which action should the nurse plan to prevent aspiration in a high-risk patient? a. Turn and reposition an immobile patient at least every 2 hours. b. Place a patient with altered consciousness in a side-lying position c. Insert a nasogastric tube for feeding a patient with high calorie needs. d. Monitor respiratory symptoms in a patient who is immunosuppressed.
B
6. To detect early signs or symptoms of inadequate oxygenation, the nurse would examine the patient for?a. dyspnea and hypotensionb.apprehension and restlessnessc.cyanosis and cool clammy skind.increase urine output and diaphoresis
B
8. How will the nurse assess for flank tenderness in a patient with suspected pyelonephritis? a. Palpate along both sides of the lumbar vertebral column. b. Strike a flat hand covering the costovertebral angle (CVA). c. Push fingers upward into the two lowest intercostal spaces. d. Percuss between the iliac crest and ribs at the midaxillary line.
B
8. The nurse observes that a patient with respiratory disease experiences a decrease in SpO2 from 93% to 88% while the patient is ambulating. What is the priority action of the nurse? a. Notify the health care provider. b. Administer PRN supplemental O2 c. Document the response to exercise. d. Encourage the patient to pace activity
B
A pregnant woman with HIV is seen at the clinic. The patient states, "I am very nervous about making my baby sick." Which information will the nurse include when teaching the patient? a. The antiretroviral medications used to treat HIV infection are teratogenic. b. Most infants born to HIV-positive mothers are not infected with the virus. c. Because it is an early stage of HIV infection, the infant will not contract HIV. d. Her newborn will be born with HIV unless she uses antiretroviral therapy (ART).
B
Nursing staff on a hospital unit are reviewing rates of HAI of the urinary tract. Which nursing action will be most helpful in decreasing the risk for urinary HAI in patients admitted to the hospital? a. Testing urine with a dipstick daily for nitrites b. Avoiding unnecessary urinary catheterizations c. Encouraging adequate oral fluid and nutritional intake d. Providing perineal hygiene to patients daily and as needed
B
The RN caring for an HIV-patient admitted with Tb can delegate which action to UAP? a. Teach the patient how to dispose of tissues with respiratory secretions. b. Stock the patient's room with the necessary personal protective equipment. c. Interview the patient to obtain the names of family members and close contacts. d. Tell the patient's family members the reason for the use of airborne precautions.
B
The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute HIV infection. Which action would be appropriate for the nurse to take? a. Instruct the patient to apply ice to the neck. b. Explain to the patient that this is an expected finding. c. Request that an antibiotic be prescribed for the patient. d. Advise the patient that this indicates influenza infection.
B
Which assessment finding for a patient who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider? a. Complaint of flank pain c. Cloudy and foul-smelling urine b. Blood pressure 90/48 mm Hg d. Temperature 100.1° F
B
Which information about a patient population would be most useful to help the nurse plan for HIV testing needs? a. Age c. Symptoms b. Lifestyle d. Sexual orientation
B
3. A diabetic patient's (ABG) results are pH 7.28; PaCO2 34 mm Hg; PaO2 85 mm Hg; HCO3- 18 mEq/L. The nurse would expect which finding a. Intercostal retractions c. Low oxygen saturation (SpO2) b. Kussmaul respirations d. Decreased venous O2 pressure
B .
A patient with acute shortness of breath is admitted to the hospital. Which action should the nurse take during the initial assessment of the patient? A. Ask the patient to lie down to complete a full physical assessment. B. Briefly ask specific questions about this episode of respiratory distress. C. Complete the admission database to check for allergies before treatment. D. Delay the physical assessment to first complete pulmonary function tests.
B .
10. The home health nurse is visiting a patient with COPD. Which nursing action is appropriate to implement for a nursing diagnosis of impaired breathing pattern related to anxiety? a. Titrate O2 to keep saturation at least 90%. b. Teach the patient how to use pursed-lip breathing. c. Discuss a high-protein, high-calorie diet with the patient. d. Suggest the use of over-the-counter sedative medications.
B .
21. The nurse monitors a patient in the emergency department after chest tube placement for a hemopneumothorax. The nurse is most concerned if which assessment finding is observed? a. A large air leak in the water-seal chamber b. 400 mL of blood in the collection chamber c. Complaint of pain with each deep inspiration d. Subcutaneous emphysema at the insertion site
B .
24. A patient who has a right-sided chest tube after a thoracotomy has continuous bubbling in the suction-control chamber of the collection device. Which action by the nurse is appropriate? a. Adjust the dial on the wall regulator . b. Continue to monitor the collection device. c. Document the presence of a large air leak. d. Notify the surgeon of a possible pneumothorax.
B .
28. A patient with a pleural effusion is scheduled for a thoracentesis. Which action should the nurse take to prepare the patient for the procedure? a. Start a peripheral IV line to administer sedatives. b. Position the patient sitting up on the side of the bed. c. Obtain a collection device to hold 3 liters of pleural fluid. d. Remind the patient not to eat or drink anything for 6 hours.
B .
37. The nurse receives change-of-shift report on the following four patients. Which patient should the nurse assess first? a. A 23-yr-old patient with cystic fibrosis who has pulmonary function testing scheduled b. A 46-yr-old patient on bed rest who is complaining of sudden onset of shortness of breath c. A 77-yr-old patient with TB who has four medications due in 15 minutes d. A 35-yr-old patient who was admitted with pneumonia and has a temperature of 100.2° F
B .
4. The nurse provides discharge instructions to a patient who was hospitalized for pneumonia. Which statement, if made by the patient, indicates a good understanding of the instructions? a. "I will call my health care provider if I still feel tired after a week." b. "I will continue to do deep breathing and coughing exercises at home. c. "I will schedule two appointments for the pneumonia and influenza vaccines." d. "I will cancel my follow-up chest x-ray appointment if I feel better next week."
B .
According to the CDC guidelines, which PPE will the nurse put on before assessing a patient who is on contact precautions for C.difficile (SATA)? a. Mask b. Gown c. Gloves d. Shoe covers e. Eye protection .
B,C
10. A patient who is taking Rifampin for tuberculosis calls the clinic and reports having orange discolored urine and tears. Which response by the nurse reflects accurate knowledge about the medication and the patient's illness? a. Ask the patient about any visual changes in red-green color discrimination . b. Question the patient about experiencing shortness of breath, hives, or itching. c. Explain that orange discolored urine and tears are normal while taking this medication. d. Advise the patient to stop the drug and report the symptoms to the health care provider.
C
11. A patient who has a history of COPD was hospitalized for increasing shortness of breath and chronic hypoxemia (SaO2 levels of 89% to 90%). In planning for discharge, which action by the nurse will be most effective in improving compliance with discharge teaching? a. Have the patient repeat the instructions immediately after teaching. b. Accomplish the patient teaching just before the scheduled discharge. c. Arrange for the patient's caregiver to be present during the teaching. d. Start giving the patient discharge teaching during the admission process.
C
11. A patient with COPD has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which intervention would be most appropriate for the nurse to include in the plan of care? a. Encourage increased intake of whole grains . b. Increase the patient's intake of fruits and fruit juices c. Offer high-calorie protein snacks between meals and at bedtime . d. Assist the patient in choosing foods with high vegetable content.
C
12. A patient diagnosed with TB is homeless and has a history of alcohol abuse. Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen? a. Repeat warnings about the high risk for infecting others several times. b. Give the patient written instructions about how to take the medications. c. Arrange for a daily meal and drug administration at a community center. d. Arrange for the patient's friend to administer the medication on schedule.
C
12. The nurse interviews a patient with a new diagnosis of COPD. Which information is most specific in confirming a diagnosis of chronic bronchitis? a. The patient tells the nurse about a family history of bronchitis. b. The patient indicates a 30 pack-year cigarette smoking history. c. The patient reports a productive cough for 3 months every winter. d. The patient denies having respiratory problems until the past 12 months.
C
13. A nurse is caring for a patient who has had a total laryngectomy and radical neck dissection. During the first 24 hours after surgery what is the priority nursing action? a. Monitor the incision for bleeding. b. Maintain adequate IV fluid intake. c. Keep the patient in semi-Fowler's position . d. Teach the patient to suction the tracheostomy
C
15. The nurse is caring for a patient with cor pulmonale. The nurse should monitor the patient for which expected finding? a. Chest pain c. Peripheral edema b. Finger clubbing d. Elevated temperature
C
16. An occupational health nurse works at a manufacturing plant where there is potential exposure to inhaled dust. Which action recommended by the nurse is intended to prevent lung disease? a. Treat workers with pulmonary fibrosis. b. Teach about symptoms of lung disease. c. Require the use of protective equipment. d. Monitor workers for coughing and wheezing.
C
17. A patient hospitalized with COPD is being discharged home on O2 therapy. Which instruction should the nurse include in the discharge teaching? a. Travel is not possible with the use of O2 devices . b. O2 flow should be increased if the patient has more dyspnea. c. O2 use can improve the patient's prognosis and quality of life. d. Storage of O2 requires large metals tanks that each last 4 to 6 hours.
C
17. A patient in metabolic alkalosis is admitted to the emergency department with the O2 saturation of 94%. Which action should the nurse expect to take next? a. Complete a head-to-toe assessment. b. Administer an inhaled bronchodilator. c. Place the patient on high-flow oxygen. d. Obtain repeat ABGs
C
18. After the nurse has received change-of-shift report, which patient should the nurse assess first? a. A patient with pneumonia who has crackles in the right lung base b. A patient with chronic bronchitis who has a low forced vital capacity c. A patient with possible lung cancer who has just returned after bronchoscopy d. A patient with hemoptysis and a 16-mm induration after tuberculin skin testing
C
19. Postural drainage with percussion and vibration is ordered twice daily for a patient with chronic bronchitis. Which intervention should the nurse include in the plan of care? a. Schedule the procedure 1 hour after the patient eats. b. Maintain the patient in the lateral position for 20 minutes. c. Give the prescribed albuterol before the therapy. d. Perform percussion before assisting the patient to the drainage position.
C
20. Which information from a patient's urinalysis requires that the nurse notify the health care provider? a. pH 6.2 c. WBC 20 to 26/hpf b. Trace protein d. Specific gravity 1.021
C
23. A 55-yr-old patient with increasing dyspnea is being evaluated for a possible diagnosis of COPD. When teaching a patient about pulmonary spirometry for this condition, what is the most important question the nurse should ask? a. "Are you claustrophobic?" b. "Are you allergic to shellfish?" c. "Have you taken any bronchodilators today?" d. "Do you have any metal implants or prostheses?"
C
29. Which instruction should the nurse include in an exercise teaching plan for a patient with COPD? a. "Avoid upper body exercise to prevent dyspnea." b. "Stop exercising if you start to feel short of breath." c. "Use the bronchodilator before you start to exercise." d. "Breathe in and out through the mouth while you exercise."
C
3. A patient is scheduled for spirometry. Which action should the nurse take to prepare the patient for this procedure? a. Give the rescue medication immediately before testing. b. Administer oral corticosteroids 2 hours before the procedure. c. Withhold bronchodilators for 6 to 12 hours before the examination. d. Ensure that the patient has been NPO for several hours before the test.
C
3. Which information will the nurse include when teaching the patient with UTI about the use of phenazopyridine? a. Take phenazopyridine for at least 7 days. b. Phenazopyridine may cause photosensitivity c. Phenazopyridine may change the urine color d. Take phenazopyridine before sexual intercourse.
C
4. A patient who is diagnosed with AIDS tells the nurse,"I feel obsessed with morbid thoughts about dying." Which response by the nurse is appropriate? a. "Thinking about dying will not improve the course of AIDS." b. "Do you think that taking an antidepressant might be helpful?" c. "Can you tell me more about the thoughts that you are having?" d. "It is important to focus on the good things about your life now."
C
4. The nurse has just auscultated coarse crackles bilaterally on a patient with a tracheostomy tube in place. If the patient is unsuccessful in coughing up secretions, what action should the nurse take? a. Encourage increased incentive spirometer use. b. Encourage the patient to increase oral fluid intake. c. Put on sterile gloves and use a sterile catheter to suction. d. Preoxygenate the patient for 3 minutes before suctioning.
C
40. The nurse notes that a patient has incisional pain, a poor cough effort, and scattered coarse crackles after a thoracotomy. Which action should the nurse take first? a. Assist the patient to sit upright in a chair. b. Splint the patient's chest during coughing c. Medicate the patient with prescribed morphine. d. Observe the patient use the incentive spirometer.
C
43. A patient has acute bronchitis with a nonproductive cough and wheezes. Which topic should the nurse plan to include in the teaching plan? a. Purpose of antibiotic therapy b. Ways to limit oral fluid intake c. Appropriate use of cough suppressants d. Safety concerns with home O2 therapy
C
44. Which action by the nurse will be most effective in decreasing the spread of pertussis in a community setting? a. Providing supportive care to patients diagnosed with pertussis b. Teaching family members about the need for careful hand washing c. Teaching patients about the need for adult pertussis immunizations d. Encouraging patients to complete the prescribed course of antibiotics
C
5. A patient with a tracheostomy has a new order for a fenestrated tracheostomy tube. Which action should the nurse include in the plan of care in collaboration with the speech therapist? a. Leave the tracheostomy inner cannula inserted at all times. b. Place the decannulation cap in the tube before cuff deflation. c. Assess the ability to swallow before using the fenestrated tube. d. Inflate the tracheostomy cuff during use of the fenestrated tube.
C
6. A patient with a chronic cough is scheduled to have a bronchoscopy with biopsy. Which intervention will the nurse implement directly after the procedure? a. Encourage the patient to drink clear liquids. b. Place the patient on bed rest for at least 4 hours. c. Keep the patient NPO until the gag reflex returns d. Maintain the head of the bed elevated 90 degrees
C
7. The health care provider writes an order for bacteriologic testing for a patient who has a positive Tb skin test. Which action should the nurse take? a. Teach about the reason for the blood tests. b. Schedule an appointment for a chest x-ray. c. Teach the patient about providing specimens for 3 consecutive days . d. Instruct the patient to collect several separate sputum specimens today.
C
7. The nurse completes a shift assessment on a patient admitted in the early phase of heart failure. When auscultating the patient's lungs, which finding would the nurse most likely hear? a. Continuous rumbling, snoring, or rattling sounds mainly on expiration b. Continuous high-pitched musical sounds on inspiration and expiration c. Discontinuous, high-pitched sounds of short duration during inspiration d. A series of long-duration, discontinuous, low-pitched sounds during inspiration
C
9. The nurse teaches a patient about pulmonary spirometry testing. Which statement, if made by the patient, indicates teaching was effective? a. "I should use my inhaler right before the test." b. "I won't eat or drink anything 8 hours before the test." c. "I will inhale deeply and blow out hard during the test." d. "My blood pressure and pulse will be checked every 15 minutes."
C
A patient informed of a positive rapid antibody test result for HIV is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time? a. Teach the patient how to reduce risky behaviors. b. Inform the patient about the available treatments. c. Remind the patient about the need to return for retesting to verify the results. d. Ask the patient to identify individuals who had intimate contact with the patient
C
A patient treated for HIV for 6 years has developed fat redistribution to the trunk with wasting of the arms, legs, and face. What recommendation will the nurse give to the patient? a. Review foods that are higher in protein. b. Teach about the benefits of daily exercise. c. Discuss a change in antiretroviral therapy. d. Talk about treatment with antifungal agents.
C
A patient who uses injectable illegal drugs asks the nurse about preventing AIDS. Which response by the nurse is best? a. "Clean drug injection equipment before each use." b. "Ask those who share equipment to be tested for HIV." c. "Consider participating in a needle-exchange program." d. "Avoid sexual intercourse when using injectable drugs."
C
After administration of the naloxone, Luis awakens and is complaining of severe pain. He asks for his pain button. What is the most appropriate response for the nurse at this time? A) Give me a few minutes to consult with the charge nurse." B) "You are breathing just fine now, here is your pain button." C)"I will talk to the doctor to adjust your medication so you can get relief."" D)I don't think you should have any more pain medication."
C
Naloxone (Narcan) helps to reverse the effects of opioid overdose that causes respiratory depression. When administering Naloxone to a patient in the hospital setting, the nurse should complete the following steps. A) Notify the physician, call a rapid response, immediately inject Naloxone IM that is stored in the code cart. B) Flush the IV, administer Naloxone IV in the closest port to the nurse, stop the PCA pump. C) Stop the PCA pump, flush the IV line, inject Naloxone IV into the IV line closes to the patient. D) Notify the physician, call the code team, administer Naloxone IV through the closet hub to the patient.
C
The nurse designs a program to decrease the (HIV) infection in the adolescent and young adult populations. Which information should the nurse assign as the highest priority? a. Methods to prevent perinatal HIV transmission b. Ways to sterilize needles used by injectable drug users c. Prevention of HIV transmission between sexual partners d. Means to prevent transmission through blood transfusions
C
The nurse is caring for a patient who is HIV and ART. Which information is most important for the nurse to address when planning care? a. The patient complains of feeling "constantly tired." b. The patient can't explain the effects of indinavir (Crixivan). c. The patient reports missing some doses of zidovudine (AZT). d. The patient reports having no side effects from the medications.
C
The nurse prepares to administer the following medications to a patient with HIV. Which medication is most important to administer at the scheduled time? a. Nystatin tablet b. Oral acyclovir (Zovirax) c. Oral saquinavir (Invirase) d. Aerosolized pentamidine (NebuPent) ANS
C
Using the illustrated technique, the nurse is assessing for which finding in a patient with COPD? a. Hyperresonance c. Reduced excursion b. Tripod positioning d. Accessory muscle use
C
Which of these patients who have arrived at HIV clinic should the nurse assess first? a. Patient whose rapid HIV-antibody test is positive b. Patient whose CD4+ dropped to 250 c. Patient who has had 10 liquid stools in the last 24 hours d. Patient who has nausea from prescribed antiretroviral drugs
C
Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the pts (HIV) status is unknown? a. Needle stick injury with a suture needle during a surgery b. Splash into the eyes while emptying a bedpan containing stool c. Needle stick with a needle and syringe used for a venipuncture d. Contamination of open skin lesions with patient vaginal secretions
C
13. After 2 months of TB treatment with isoniazid, rifampin (Rifadin), pyrazinamide, and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next? a. Teach about drug-resistant TB. b. Schedule directly observed therapy. c. Ask the patient whether medications have been taken as directed. d. Discuss the need for an injectable antibiotic with the health care provider.
C .
3. A patient with bacterial pneumonia has coarse crackles and thick sputum. Which action should the nurse plan to promote airway clearance? a. Restrict oral fluids during the day. b. Teach pursed-lip breathing technique. c. Assist the patient to splint the chest when coughing. d. Encourage the patient to wear the nasal O2 cannula.
C .
7. During the respiratory assessment of the older adults, the nurse would expect to find (select all):a. a vigorous coughb.increased chest expansionc.increased residual volumed. increased breath sounds in the lung apicese. increase anteroposterior AP chest diameter
C,E
6. A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days. Which assessment data obtained by the nurse indicates that the treatment is effective? a. Bronchial breath sounds are heard at the right base. b. The patient coughs up small amounts of green mucus. c. WBC count is 9000/µL. d. Increased tactile fremitus is palpable over the right chest.
C.
9. The nurse teaches a patient about the transmission (TB). Which statement, if made by the patient, indicates that teaching was effective? a. "I will take the bus instead of driving." b. "I will stay indoors whenever possible." c. "My spouse will sleep in another room." d. "I will keep the windows closed at home."
C.
10. A patient who was involved in a motor vehicle crash has had a tracheostomy placed to allow for continued mechanical ventilation. How should the nurse interpret the following arterial blood gas results: pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L? a. Metabolic acidosis c. Respiratory acidosis b. Metabolic alkalosis d. Respiratory alkalosis
D
13. The nurse admits a patient who has a diagnosis of an acute asthma attack. Which statement indicates that the patient may need teaching regarding medication use? a. "I have not had any acute asthma attacks during the past year." b. "I became short of breath an hour before coming to the hospital." c. "I've been taking Tylenol 650 mg every 6 hours for chest wall pain." d. "I've been using my albuterol inhaler more frequently over the last 4 days."
D
15. The nurse analyzes the results of a patient's arterial blood gases (ABGs). Which finding would require immediate action? a. HCO3 is 31 mEq/L. b. SaO2 is 92%. c. PaCO2 is 31 mm Hg. d. PaO2 is 59 mm Hg.
D
16. Which assessment finding indicates that the nurse should take immediate action for an older patient? a. Weak cough effort c. Dry mucous membranes b. Barrel-shaped chest d. Bilateral basilar crackles
D
19. The laboratory has just called with the ABG results on four patients. Which result is most important for the nurse to report immediately to the health care provider? a. pH 7.34, PaO2 82 mm Hg, PaCO2 40 mm Hg, and O2 sat 97% b. pH 7.35, PaO2 85 mm Hg, PaCO2 50 mm Hg, and O2 sat 95% c. pH 7.46, PaO2 90 mm Hg, PaCO2 32 mm Hg, and O2 sat 98% d. pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96%
D
2. The nurse prepares a patient with a left-sided pleural effusion for a thoracentesis. How should the nurse position the patient? a. High-Fowler's position with the left arm extended b. Supine with the head of the bed elevated 30 degrees c. On the right side with the left arm extended above the head d. Sitting upright with the arms supported on an over bed table
D
23. When assessing a patient who has just arrived after an automobile accident, the emergency department nurse notes tachycardia and absent breath sounds over the right lung. For which intervention will the nurse prepare the patient? a. Emergency pericardiocentesis c. Bronchodilator administration b. Stabilization of the chest wall d. Chest tube connected to suction
D
32. A patient who has just been admitted with pneumococcal pneumonia has a temperature of 101.6° F with a frequent cough and is complaining of severe pleuritic chest pain. Which prescribed medication should the nurse give first? a. Codeine c. Acetaminophen b. Guaifenesin d. Piperacillin/tazobactam (Zosyn)
D
33. A patient is diagnosed with HIV and TB disease. Which information obtained by the nurse is most important to communicate to the health care provider? a. The Mantoux test had an induration of 7 mm. b. The chest-x-ray showed infiltrates in the lower lobes c. The patient has a cough that is productive of blood-tinged mucus .d. The patient is being treated with ATR for HIV
D
34. A patient with pneumonia has a fever of 101.4° F, a nonproductive cough, and an O2 saturation of 88%. The patient complains of weakness, fatigue, and needs assistance to get out of bed. Which nursing diagnosis should the nurse assign as the priority? a. Hyperthermia related to infectious illness b. Impaired transfer ability related to weakness c. Ineffective airway clearance related to thick secretions d. Impaired gas exchange related to respiratory congestion
D
36. A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. The nurse finds a heart rate of 142 beats/min, blood pressure of 100/60 mm Hg, and respirations of 42 breaths/min. Which action should the nurse take first? a. Administer anticoagulant drug therapy. b. Notify the patient's health care provider. c. Prepare patient for CT d. Elevate the head of the bed to a semi-Fowler's position.
D
38. The nurse is performing TB skin tests in a clinic that has many patients who have immigrated to the United States. Which question is most important for the nurse to ask before the skin test? a. "Do you take any OTC medications?" b. "Do you have any family members with a history of TB? c. "How long has it been since you moved to the United States?" d. "Did you receive the BCG vaccine for TB?"
D
49. After change-of-shift report, which patient should the nurse assess first? a. A 72-yr-old with cor pulmonale who has 4+ bilateral edema in his legs and feet b. A 28-yr-old with a history of a lung transplant and a temperature of 101° F c. A 40-yr-old with a pleural effusion who is complaining of severe stabbing chest pain d. A 64-yr-old with lung cancer and tracheal deviation after subclavian catheter insertion
D
5. The nurse palpates the posterior chest while the patient says "99" and notes absent fremitus. Which action should the nurse take next? a. Palpate the anterior chest and observe for barrel chest. b. Encourage the patient to turn, cough, and deep breathe. c. Review the chest x-ray report for evidence of pneumonia. d. Auscultate anterior and posterior breath sounds bilaterally.
D
8. A patient is admitted with TB. The nurse should question a health care provider's order to discontinue airborne precautions unless which assessment finding is documented? a. Chest x-ray shows no upper lobe infiltrates. b. TB medications have been taken for 6 months. c. Mantoux testing shows an induration of 10 mm. d. Sputum smears for acid-fast bacilli are negative.
D
A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with PCP and a CD4+ T-cell count of less than 200 cells/L. Based on diagnostic criteria established by CDC, which statement by the nurse is correct? a. "The patient will develop symptomatic HIV infection within 1 year." b. "The patient meets the criteria for a diagnosis of acute HIV infection." c. "The patient will be diagnosed with asymptomatic chronic HIV infection." d. "The patient has developed acquired immunodeficiency syndrome (AIDS)."
D
A patient with HIV has a CD4+ cell count of 400/µL. Which factor is most important for the nurse to determine before the initiation ART for this patient? a. CD4+cell count trajectory b. HIV genotype and phenotype c. Patient's tolerance for potential medication side effects d. Patient's ability to follow a complex medication regimen
D
A patient with HIV has developed Mycobacterium avium complex infection. Which outcome would be appropriate for the nurse to include in the plan of care? a. The patient will be free from injury. b. The patient will receive immunizations. c. The patient will have adequate oxygenation. d. The patient will maintain intact perineal skin.
D
A young adult female patient who has HIV has a new prescription for efavirenz (Sustiva). Which information is most important to include in the medication teaching plan? a. Take this medication on an empty stomach. b. Take this medication with a full glass of water. c. You may have vivid and bizarre dreams as a side effect. d. Continue to use contraception while taking this medication.
D
The nurse will most likely prepare a medication teaching plan about ART for which patient? a. Patient who is HIV(-)but has unprotected sex with multiple partners b. Patient who has HIV 15 years ago and now has a CD4+ count of 840/µL c. HIV patient with a CD4+ of 160/µL who drinks a fifth of whiskey daily d. Patient who has HIV 2 years ago and now has CMV retinitis
D
Which assessment data reported by a patient is consistent with a lower UTI a. Low urine output c. Nausea and vomiting b. Bilateral flank pain d. Burning on urination
D
Which finding by the nurse will be most helpful in determining whether a 67-yr-old patient with BPH has an upper UTI? a. Bladder distention c. Suprapubic discomfort b. Foul-smelling urine d. Costovertebral tenderness
D
Which nursing action will be most useful in assisting a college student to adhere to a newly (ART) regimen? a. Give the patient detailed information about possible medication side effects. b. Remind the patient of the importance of taking the medications as scheduled. c. Encourage the patient to join a support group for students who are HIV positive. d. Check the patient's class schedule to help decide when the drugs should be taken.
D
35. The nurse supervises UAP who are providing care for a patient with right lower lobe pneumonia. The nurse should intervene if which action by UAP is observed? a. UAP assist the patient to ambulate to the bathroom. b. UAP help splint the patient's chest during coughing . c. UAP transfer the patient to a bedside chair for meals. d. UAP lower the head of the patient's bed to 15 degrees.
D .
5. The major advantage of Venturi mask is that it cana.. deliver up to 88% O2b. provide continous 100% humidityc.deliver a precise concentration of O2d. be used while a patient eats and sleeps
c
The nurse notes tidaling of the water level in the tube submerged in the water seal chamber in a patient with closed chest tube drainage, the nurse should?
continue to monitor the patient
When obtain health history from a patient suspected of having early TB, what manifestations should the nurse ask the patient about?
fatigue,low grade fever, night sweats
Which pneumonia patients would the nurse suspect aspiration as the likely cause?
seizures, head injury, nasogastric tube feedings
An appropriate nursing intervention for a patient with pneumonia with the nursing diagnosis of ineffective airway clearance related to thick secretions and fatigue would be to?
teach patient how to cough effectively to bring secretions to the mouth
