Med Surg Exam 2

Which action should you take first when a patient develops a nosebleed? A. Pack both nares tightly with 1/2-inch ribbon gauze. B. Pinch the lower portion of the nose for 10 minutes. C. Prepare supplies that will be needed for cauterization. D. Apply ice compresses over the patient's nose and cheeks.

b

Which of the following respiratory physiological changes occur as a result of aging? A. Increase elastic recoil B. Decrease functioning alveoli C. Increase cough force D. Increase response to high CO2 level

b

Which of the following would cause the medulla oblongata to increase the respiratory rate? A. Too much oxygen in blood stream B. Too much carbon dioxide in blood stream C. Decrease in metabolic needs

b

patient with complicated deviated septum is hospitalized to have septoplasty. Which of the following findings must you report to the surgeon before the surgery? A. Serum sodium is 134 mEq/L. B. PT 12 seconds. C. Serum potassium is 4.8 mEq/L. D. Platelets counts is 120,000/ L

d

True or False? Because the pressure of CO2 is higher in the blood vessels than the pressure of CO2 in the lungs, the CO2 moves from the blood to the lungs.

TRUE

A 75-year-old patient breathing room air has the following arterial blood gas (ABG) results: pH 7.40, PaO2 72 mm Hg, SaO2 92%, PaCO2 40 mm Hg. An appropriate action by the nurse is to A. encourage deep breathing and coughing to open the alveoli. B. repeat the ABGs within an hour to validate the findings. C. document the results in the patient's record D. initiate pulse oximetry for continuous monitoring of the patient's oxygen status.

a

A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. You find a heart rate of 142, BP reading of 100/60, and respirations of 42. Your first action should be to A. elevate the head of the bed to 45 to 60 degrees. B. administer the ordered pain medication. C. notify the patient's health care provider. D. offer emotional support and reassurance.

a

A staff nurse has a tuberculosis (TB) skin test of 16-mm induration. A chest radiograph is negative, and the nurse has no symptoms of TB. The occupational health nurse will plan on teaching the staff nurse about the a) use and side effects of isoniazid (INH). b) standard four-drug therapy for TB. c) need for annual repeat TB skin testing. d) bacille Calmette-Guérin (BCG) vaccine.

a

After 2 months of tuberculosis (TB) treatment with a standard four-drug regimen, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should you take next? a) Ask the patient whether medications have been taken as directed. b) Discuss the need to use some different medications to treat the TB. c) Schedule the patient for directly observed therapy three times weekly. d) Educate about using a 2-drug regimen for the last 4 months of treatment

a

Auscultating bronchial breath sounds over the lung fields is considered abnormal. a. True b. False

a

The most reliable and sensitive test of gas exchange is: A. Pulse Oxymetry B. ABG C. Chest X- ray D. Respiration rate

a

The parent of a child diagnosed with sickle-cell anemia asks the nurse about air travel with the child. Which of the following is the best response? A."Flying at high altitudes can be associated with less available oxygen, causing increased sickling." B."Flying will present a risk for infection secondary to crowds." C. "Flying does not pose any particular risks for the child with SCA." D."Air travel is not recommended, because of the unavailability of emergency medical care while in flight."

a

When teaching the patient who is receiving standard multidrug therapy for tuberculosis (TB) about possible toxic effects of the antitubercular medications, you will give instructions to notify the health care provider if the patient develops a) yellow-tinged skin. b) changes in hearing. c) orange-colored sputum. d) thickening of the fingernails.

a

Which information will you include in the patient teaching plan for a patient who is receiving rifampin (Rifadin) for treatment of tuberculosis? a) "Your urine, sweat, and tears will be orange colored." b) "Read a newspaper daily to check for changes in vision." c) "Take vitamin B6 daily to prevent peripheral nerve damage." d) "Call the health care provider if you notice any hearing loss."

a

Which of the following is expected to find in ABG of a patient with bilateral pneumonia?a. PaO2 60 mmHg b. PaO2 80 mmHg c. PaO2 90 mmHg d. PaO2 100 mmHg

a

Which of the following should be a priority nursing diagnosis for a patient who acquired bacterial pneumonia? a. Impaired gas exchange b. Fatigue c. Fluid volume excess d. Anxiety

a

While receiving an adrenergic beta2 agonist drug for asthma, the client complains of palpitations, chest pain, and a throbbing headache. What is the most appropriate nursing action? a. Withhold the drug until additional orders are obtained. b. Tell the client not to worry; these are expected side effects from the medicine. c. Ask the client to relax; then give instructions to breathe slowly and deeply for several minutes. d. Explain that the effects are temporary and will subside as the body becomes accustomed to the drug.

a

You are caring for a variety of clients. For which client is it most essential for you to implement measures to prevent pulmonary embolism? a) 59-year-old who had a knee replacement b) 60-year-old who has bacterial pneumonia c) 68-year-old who had emergency dental surgery d) 76-year-old who has a history of thrombocytopenia

a

You are obtaining a health history from a 67-year-old patient with a 40 pack-year smoking history, complaints of hoarseness and tightness in the throat, and difficulty swallowing. Which question is most important to ask? A. "How much alcohol do you drink in an average week?" B. "Do you have a family history of head or neck cancer?" C. "Have you had frequent streptococcal throat infections?" D. "Do you use antihistamines for upper airway congestion?"

a

Vancomycin is prescribed for a client with bacterial pneumonia. The prescriber orders a trough level of Vancomycin. You should have the laboratory obtain a blood sample from the client: a. Halfway between two IVPB administrations b. Immediately before administering the IVPB c. Anytime it is convenient for the client and laboratory

b

Which of the following is part of the respiratory tract? Choose all that apply. A. Bronchi B. Pharynx C. Larynx D. Sinuses

a b c d

A patient with TB has been admitted to the hospital and is placed in an airborne infection isolation room. Which of the following should the patient be taught (select all that apply)? a) Expect routine TST to evaluate infection. b) Visitors will not be allowed while in airborne isolation. c) Take all medications for full length of time to prevent multidrug-resistant TB. d) Wear a standard isolation mask if leaving the airborne infection isolation room. e) Maintain precautions in airborne infection isolation room by coughing into a paper tissue.

a c d e

The functional unit of the respiratory system is

alveoli

A client is admitted to the hospital with a diagnosis of an exacerbation of asthma. What should you plan to do to best help this client? a. Determine the client's emotional state. b. Give prescribed drugs to promote bronchiolar dilation. c. Provide education about the impact of a family history. d. Encourage the client to use an incentive spirometer routinely.

b

On auscultation of a patient's lungs, you hear short, high-pitched sounds during exhalation in the lower 1/3 of both lungs. You should record this finding as A. expiratory crackles at the bases. B. expiratory wheezes in both lungs. C. abnormal lung sounds in the bases of both lungs. D. pleural friction rub in the right and left lower lobes.

b

The following 4 patients are diagnosed with pneumonia. Which one should you see the first? a. 30 years old; febrile; RR 18; SpO2 94%; hacking cough b. 45 years old; febrile; RR 23; SpO2 88%; think productive cough c. 64 years old; afebrile; RR 20; SpO2 96%; no cough d. 72 years old; febrile; RR 19; SpO2 94%; no cough

b

The teaching plan for a patient with acute sinusitis will need to include of the following interventions EXCEPT A. Taking a hot shower will increase sinus drainage and decrease pain. B. Over-the-counter (OTC) antihistamines can be used to relieve congestion and inflammation. C. Saline nasal spray can be made at home and used to wash out secretions. D. Blowing the nose forcefully should be avoided to decrease nosebleed risk.

b

Which of these nursing actions can the RN working in a long-term care facility delegate to an experienced LPN/LVN who is caring for a patient with a permanent tracheostomy? A. Assessing the patient's risk for aspiration B. Suctioning the tracheostomy when needed C. Educating the patient about self-care of the tracheostomy D. Determining the need for replacement of the tracheostomy tub

b

You are performing tuberculosis (TB) screening in a clinic that has many patients who have immigrated to the United States. Before doing a TB skin test on a patient, which question is most important for you to ask? a) "Is there any family history of TB?" b) "Have you received the bacille Calmette-Guérin (BCG) vaccine for TB?" c) "How long have you lived in the United States?" d) "Do you take any over-the-counter (OTC) medications?"

b

You obtain the following assessment data in a 76-year-old patient who has influenza. Which information will be most important to communicate to the health care provider? A. Fever of 100.4° F (38° C) B. Diffuse crackles in the lungs C. Sore throat and frequent cough D. Myalgia and persistent headache

b

patient with a pleural effusion is scheduled for a thoracentesis. Before the procedure, you will plan to a) start a peripheral intravenous line to administer the necessary sedative drugs. b) position the patient sitting upright on the edge of the bed and leaning forward. c) remove the water pitcher and remind the patient not to eat or drink anything for 6 hours. d) instruct the patient about the importance of incentive spirometer use after the procedure.

b

pneumocystis pneumonia is a pulmonary fungal infection commonly seen is: a. Patients with lung cancer b. Patients with AIDS c. Patients with cystic fibrosis d. Patients with COPD

b

A client is admitted to the hospital with a diagnosis of atrial fibrillation, and the practitioner suspects mitral valve stenosis. When obtaining a health history, the nurse determines that it is most significant if the client presents a history of: A. Cystitis at age 28 B. Pleurisy at age 20 C. Strep throat at age 12 D. German measles at age 6

c

A patient who had a total laryngectomy has a nursing diagnosis of hopelessness related to loss of control of personal care. Which information obtained by the nurse is the best indicator that the problem identified in this nursing diagnosis is resolving? A. The patient lets the spouse provide tracheostomy care. B. The patient allows the nurse to suction the tracheostomy. C. The patient asks how to clean the tracheostomy stoma and tube. D. The patient uses a communication board to request "No Visitors."

c

After a patient has undergone a septoplasty, which nursing intervention will be included in the plan of care? A. Educate the patient about how to safely remove and reapply nasal splint. B. Reassure the patient that the nose will look normal when the swelling subsides C. Instruct the patient to keep the head elevated for 48 hours to minimize swelling and pain. D. Teach the patient to use nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control.

c

After discussing management of upper respiratory infections (URI) with a patient who has acute viral rhinitis, you determine that additional teaching is needed when the patient says: A. "I can take acetaminophen (Tylenol) to treat discomfort." B. "I will drink lots of juices and other fluids to stay hydrated." C. "I can use my nasal decongestant spray until the congestion is all gone." D. "I will watch for changes in nasal secretions or the sputum that I cough up."

c

After you have received change-of-shift report about the following four patients, which patient should you assess first? A. A 77-year-old patient with tuberculosis (TB) who has four antitubercular medications due in 15 minutes B. A 23-year-old patient with cystic fibrosis who has pulmonary function testing scheduled C. A 46-year-old patient who has a deep vein thrombosis and is complaining of sudden onset shortness of breath D. A 35-year-old patient who was admitted the previous day with pneumonia and has a temperature of 100.2° F (37.8° C)

c

The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test. Which action will you take? a. Repeat the tuberculin skin testing. b) Teach about the reason for the blood tests. c) Obtain consecutive sputum specimens from the patient for 3 days. d) Instruct the patient to expectorate three specimens as soon as possible.

c

When assessing a client with pleural effusion, you expect to identify: a) Moist crackles at the posterior of the lungs b) Deviation of the trachea toward the involved side c) Reduced or absent breath sounds at the base of the lung d) Increased resonance with percussion of the involved area

c

When caring for a patient who is hospitalized with active tuberculosis (TB), you observe a family member who is visiting the patient. You will need to intervene if the family member a) washes the hands before entering the patient's room. b) hands the patient a tissue from the box at the bedside. c) puts on a surgical face mask before visiting the patient. d) brings food from a "fast-food" restaurant to the patient.

c

When teaching the patient with allergic rhinitis about management of the condition, you should explain that A. over-the-counter (OTC) antihistamines cause sedation, so prescription antihistamines are usually ordered. B. corticosteroid nasal sprays will reduce inflammation, but systemic effects limit their use. C. Identification and avoidance of environmental triggers are the best way to avoid symptoms. D. Use of oral antihistamines for a few weeks before the allergy season may prevent reactions.

c

Which of the following confirms the diagnosis of bacterial pneumonia? a. Dyspnea b. Hacking cough c. Leukocytosis d. Wheezes

c

Which of the following indicates pleural effusion? a) "Lately I can only breathe well if I sit up." b) "During the night I sometimes get the chills." c) "I get a sharp, stabbing pain when I take a deep breath." d) "I'm coughing up larger amounts of thicker mucus for the last several days."

c

Which of the following is not a typical clinical manifestation of pneumonia? a. Dyspnea b. Productive cough c. Hoarseness d. Pleuritic pain

c

You are reviewing the charts for four patients who are scheduled for their yearly physical examinations in October. Which of the following patients will require the inactivated influenza vaccination? A. A 56-year-old patient who is allergic to eggs B. A 24-year-old patient who has allergies to penicillin and the cephalosporins C. A 30-year-old patient who takes corticosteroids for rheumatoid arthritis D. A 24-year-old patient who has allergies to penicillin and the cephalosporins

c

You palpate the posterior chest while the patient says "99" and note that no vibration is felt. How should this be charted? A. Diminished expansion B. Dullness to percussion C. Absent tactile fremitus D. Decreased breath sounds

c

You recognize that the goals of teaching regarding the transmission of pulmonary tuberculosis (TB) have been met when the patient with TB a) demonstrates correct use of a nebulizer. b) washes dishes and personal items after use. c) covers the mouth and nose when coughing. d) reports daily to the public health department.

c

when assessing the respiratory system of a 78-year-old patient, which finding indicates that you should take immediate action? A. The chest appears barrel shaped. B. The patient has a weak cough effort. C. Crackles are heard from the lung bases to the midline. D. Hyperresonance is present across both sides of the chest.

c

when auscultating a patient's chest while the patient takes a deep breath, you hear loud, high-pitched, "blowing" sounds at both lung bases. You will document these as A. normal sounds. B. vesicular sounds. C. abnormal sounds D. adventitious sounds

c

A 65-year-old client with exacerbation of chronic obstructive pulmonary disease (COPD) informs you that he received his pneumonia vaccine 6 years ago. Which of the following is essential to include in the plan of care during the client's hospital admission? a. No further nursing action is needed. b. Document the previous immunization on the client record. c. Explain to the client that he can only be revaccinated during the fall months. d. Explain to the patient that he will need another pneumonia vaccine.

d

A patient scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx asks you, "How will I talk after the surgery?" Your best response is: A. "You will breathe through a permanent opening in your neck, but you will not be able to communicate orally." B. "You won't be able to talk right after surgery, but you will be able to speak again after the tracheostomy tube is removed." C. "You won't be able to speak as you used to, but there are artificial voice devices that will give you the ability to speak normally." D. "You will have a permanent opening into your neck, and you will need to have rehabilitation for some type of voice restoration."

d

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. Complete a full physical examination to determine the systemic effect of the respiratory distress. B. Obtain a comprehensive health history to determine the extent of any prior respiratory problems. C. Delay the physical assessment and ask family members about any history of respiratory problems. D. Perform a respiratory system assessment and ask specific questions about this episode of respiratory distress.

d

Review the following Culture and Sensitivity report of a sputum culture. What antibiotic do you expect the physician to prescribe for this patient? AmpicillinI Cephalothin R Erythromycin R GentamicinS OxacillinR a. Amoxicillin b. Cephacetrile c. Cefuroxime d. Gentamicin

d

Which information about a patient who has a recent history of tuberculosis (TB) indicates that you can discontinue airborne isolation precautions? 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) Three sputum smears for acid-fast bacilli are negative.

d

Which information will the nurse include when teaching the patient with asthma about the prescribed medications? A. Utilize the inhaled corticosteroid when shortness of breath occurs. B. Inhale slowly and deeply when using the dry-powder inhaler (DPI). C. Hold your breath for 5 seconds after using the bronchodilator inhaler. D. Tremors are an expected side effect of rapidly acting bronchodilators.

d

Who of the following is at highest risk to acquire pneumonia? a. Patient who has been using corticosteroid for 3 days. b. Patient who is 45 year and has COPD. c. Patient who has been a smoker for 5 years. d. Patient whose WBC counts is 2,000/mm3 post chemotherapy.

d

You are caring for a hospitalized 82-year-old patient who has nasal packing in place to treat a nosebleed. Which of the following assessment findings will require the most immediate action? A. The patient complains of level 7 (0 to 10 scale) pain. B. The patient's temperature is 100.1° F (37.8° C). C. The nose appears red and swollen. D. The oxygen saturation is 89%.

d

You're reviewing sputum culture procedure with a student nurse. Which of the following statements if the student says requires correction? a. I should obtain the specimen first thing in the morning. b. I should collect sputum not saliva. c. I should start the antibiotic administration as soon as I collect the specimen. d. I should follow up with the lab regarding the results by the end of the shift.

d

Zosyn (Piperacellin) 3.375 g IVPB Q 6 hours is prescribed for a patient with bacterial pneumonia. The medication is mixed with a total of 50 mL of NS 0.9% and to be delivered over 30 minutes. At what mL/hr rate will you run the IV pump? a. 25 mL/hr. b. 50 mL/hr. c. 75 mL/hr. d. 100 mL/hr.

d