nursing agency 3 final mod 2
How long is the usual course of drug treatment for a patient with active tuberculosis (TB)? a. 7 to 10 days b. 6 weeks c. 6 months d. 2 years
c.
The chest tube drainage system of the patient 36 hours after a pneumonectomy has continuous bubbling in the water seal chamber (chamber 2). When you clamp the chest tube close to the patient's dressing, the bubbling stops. What is your interpretation of this finding? a. An air leak is present at the chest tube insertion site or in the thoracic cavity. b. An air leak is present somewhere in the drainage system. c. The suction pressure applied to the system is too high. d. The suction pressure applied to the system is too low.
a
The patient is scheduled to have a bronchoscopy. Which nursing intervention is most appropriate in preparation for this procedure? a. Ensure that the patient does not smoke for 6 to 8 hours before the procedure. b. Allow the patient nothing by mouth for 4 hours before the procedure. c. Discontinue all inhalant medications 6 to 8 hours before the procedure. d. Shave the suprasternal area of the chest.
b.
The patient is using a medication that paralyzes the cilia in the airways. What should you teach this patient about this side effect? a. "Increase the amount of water you drink to prevent throat dryness." b. "Cough every hour to help bring up mucus and secretions." c. "Eat soft foods because swallowing will be more difficult." d. "Exercise slowly and infrequently to prevent wheezing
b.
The patient receiving continuous oxygen therapy by nasal cannula for an acute respiratory problem is becoming increasingly confused. What is your best first action? a. Notify the physician immediately. b. Increase the oxygen flow rate. c. Document the observation. d. Reposition the patient from a high-Fowler's to a low-Fowler's position.
b.
The patient who is scheduled to have a vertical laryngectomy asks a nurse what changes to expect in voice quality after the surgery. What is the nurse's best response? a. "You will not be able to speak above a whisper." b. "Your permanent voice will be hoarse and breathy." c. "The removal of your larynx results in permanent loss of natural speech." d. "Speech will be absent immediately following surgery but will return to normal when all swelling has resolved, usually within 6 months."
b.
What is the major difference in pathophysiology between asthma and COPD? a. Asthma is a restrictive disorder and COPD is an obstructive disorder. b. COPD results in permanent airflow obstruction and asthma is a condition of reversible airflow obstruction. c. COPD is caused by chronic exposure to inhalation irritants and the major cause of asthma is cigarette smoking. d. Asthma is the result of an inflammatory process and COPD is a result of inflammatory, infectious, and hyperresponsiveness processes.
b.
What is the physiologic consequences of CO2 narcosis? a. Excessive sleepiness in the patient with hypercarbia b. Failure of rising blood levels of CO2 to trigger more rapid and deeper respirations c. A change in the ventilation-perfusion ratio, in which ventilation exceeds perfusion d. Increase in the percentage of oxygen delivered to the patient does not result in an increased PaO2
b.
What should you teach the patient who has step II asthma that is triggered by exercise? a. "Do not engage in any form of exercise activity." b. "Use a short-acting beta agonist before engaging in exercise." c. "Avoid participating in water-related activity such as swimming, diving, or water aerobics." d. "Use systemic corticosteroids rather than inhaled corticosteroids on the days when you exercise."
b.
Which clinical change indicates the patient's COPD is becoming worse? a. Pulse pressure has increased from 35 mm HG to 40 mm Hg, b. The patient has had an unplanned weight loss of 15 pounds. c. The patient's average respiratory rate has decreased from 34 to 33. d. The patient's PaCO2 is 58 mm Hg this month compared with 64 mm Hg last month.
b.
A client with bronchial pneumonia is having difficulty maintaining airway clearance because of retained secretions. To decrease the amount of secretions retained, what should the nurse do? a. Administer continuous oxygen b.Increase fluid intake to at least 2 L a day c.Place the client in a high-Fowler position d. Instruct the client to gargle deep in the throat using warmed normal saline
b. Increased fluid intake helps to liquefy respiratory secretions, which promotes expectoration. Oxygen may dry the mucous membranes, which may thicken secretions; oxygen should be administered only when necessary. Placing the client in a high-Fowler position promotes retention of secretions; supine, prone, and Trendelenburg positions promote removal of secretions via gravity. Retained secretions are in the bronchi and trachea; gargling lubricates only the oropharynx.
Polycythemia is frequently associated with chronic obstructive pulmonary disease (COPD). Which should the nurse monitor for when assessing for this complication? a. Pallor and cyanosis b. Dyspnea on exertion c. Elevated hemoglobin d. Decreased hematocrit
c. The body attempts to compensate for decreased oxygen to tissues by increasing the number of blood cells, the oxygen-carrying component of the blood. With polycythemia, the skin, especially the face, appears flushed, not pale. Dyspnea on exertion is not specific to polycythemia; there is more than one cause of dyspnea on exertion. The hematocrit is increased with polycythemia.
Before discharge, the nurse discusses nutrition with the patient with emphysema and pneumonia. The nurse instructs the patient to do what? a. Increase intake of hot foods b. Eat three large meals per day c. Rest for 30 minutes before eating d. Exercise before meals to increase appetite
c. The patient with emphysema should conserve energy to eat and should rest for at least 30 minutes before eating to increase energy needed to eat. The patient should consume five to six small meals per day, avoid hot foods, and exercise after eating to conserve energy.
The patient is a 72-year-old man who has just been prescribed an antihistamine for viral rhinitis. The nurse should caution the patient that these medications may worsen which one of the patient's coexisting medical problems? a. Asthma b. Hypotension c. Kidney stones d. Urinary retention
d.
The patient who was treated for a "strep" throat 3 weeks ago has a recurrence of the streptococcal infection. What additional assessment data should be obtained to determine whether the patient has experienced any complications from this ongoing infection? a. Ophthalmoscopic examination of the eye b. Blood pressure in both arms c. Sputum specimen d. Urinalysis
d.
The patient with manifestations of a respiratory infection is suspected of having inhalation anthrax. In addition to standard precautions, what other infection control precautions should the nurse use until the diagnosis is certain? a. Airborne precautions b. Droplet precautions c. Contact precautions d. No additional precautions
d.
Which assessment finding should you expect in the patient with COPD? a. Decreased vocal fremitus b. Grossly bloody sputum c. Loss of the gag reflex d. Tracheal deviation
a
The patient with active tuberculosis has started therapy with isoniazid and rifampin. He reports that his urine now has an orange color. What is the nurse's best action? a. Document the report as the only action. b. Obtain a specimen for culture. c. Test the urine for occult blood. d. Notify the physician.
a.
What is the priority assessment for the patient who has undergone posterior nasal packing 1 hour ago for a posterior nosebleed? a. Assessing adequacy of the patient's airway. b. Examining the posterior pharynx for evidence of bleeding. c. Checking the oral mucous membranes for excessive dryness. d. Asking the patient to rate the pain experience on a scale of 1 to 10.
a.
Which intervention should you suggest to the patient with COPD to reduce early satiety? a. "Avoid drinking fluids just before and during meals." b. "Use a bronchodilator inhaler 30 minutes before meals." c. "Increase the amount of protein and reduce the amount of fat in your diet." d. "Practice diaphragmatic breathing against resistance at least 4 times each day."
a.
Which type of acid-base imbalance is most common among patients with COPD? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis
a.
Which statement made to the home care nurse, by the patient with severe COPD indicates a need for further discussion about management of secretions? a. "I have been drinking at least 3 quarts of water or juice each day." b. "When I cough, I lay on my side so I don't swallow the secretions." c. "My wife uses a vibrator on my back and sides to shake the mucus loose." d. "Even though it smells bad, I use the acetylcysteine nebulizer 3 times each day."
b.
Your patient with asthma is receiving aminophylline intravenously. Which manifestation alerts you to the possibility of aminophylline toxicity? a. Pulse oximetry of 93% b. Increased restlessness c. Hourly urine output of 45 mL d. Heart rate increase from 72 to 84 beats per minute
b.
When measuring the patient's pulse oximetry you find the patient to have a reading of 85%, down from 92% 1 hour ago. Which action should you perform first? a. Administer oxygen by mask or cannula. b. Document the finding. c. Verify the measurement. d. Notify the physician.
c.
What is the most common symptom of lung cancer? a. Fatigue b. Anorexia c. Hoarseness d. Persistent cough
d. A persistent cough is the most common symptom of lung cancer. It may be accompanied with blood-tinged sputum due to bleeding caused by the cancer. Later manifestations include hoarseness, which may occur due to laryngeal nerve involvement, as well as fatigue and anorexia, which are nonspecific symptoms.
A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute bronchopneumonia. The client is in moderate respiratory distress. The nurse should place the client in what position to enhance comfort? a. Side-lying with head elevated 45 degrees b.Sims with head elevated 90 degrees c.Semi-Fowler with legs elevated d. High-Fowler using the bedside table to rest the arms
d. The high-Fowler position elevates the clavicles and helps the lungs to expand, thus easing respirations. The side-lying, Sims, and semi-Fowler positions do not promote more comfortable breathing.
To promote airway clearance in a patient with pneumonia, what should the nurse instruct the patient to do? Select all that apply. a.Maintain adequate fluid intake b.Splint the chest when coughing c. Maintain a 30-degree elevation d. Maintain a semi-Fowler's position e. Instruct patient to cough at end of exhalation
a, b, e Maintaining adequate fluid intake liquefies secretions, allowing easier expectoration. The nurse should instruct the patient to splint the chest while coughing. This will reduce discomfort and allow for a more effective cough. Coughing at the end of exhalation promotes a more effective cough. The patient should be positioned in an upright sitting position (high Fowler's) with head slightly flexed.
A client is prescribed albuterol to relieve severe asthma. What adverse effect will the nurse instruct the client to anticipate? Select all that apply. a. Tremors b. Lethargy c. Palpitations d. Visual disturbances e. Decreased pulse rate
a, c Albuterol's sympathomimetic effect causes central nervous stimulation, precipitating tremors, restlessness, and anxiety. Albuterol's sympathomimetic effect causes cardiac stimulation that may result in tachycardia and palpitations. Albuterol may cause restlessness, irritability, and tremors, not lethargy. Albuterol may cause dizziness, not visual disturbances. Albuterol will cause tachycardia, not bradycardia.
The nurse is teaching a client with asthma about using a peak flow meter. Which statement by the client reflects a correct understanding of how to use a peak flow meter? Select all that apply. a. "Readings in the green zone mean that my asthma is under control." b. "If I get a reading in the yellow zone, I need to stop what I'm doing and rest, then recheck in an hour." c. "If I get a reading in the red zone, then I need to take my reliever drug and have my wife take me to the hospital." d. "I should check the peak flow readings at least twice a day." e. "I don't need to check my peak flow readings if I take a reliever drug."
a, c, d Peak flow meters are used to measure how well the client's asthma is controlled. Readings in the green zone mean the asthma is under control; however, readings in the red zone indicate a serious respiratory problem that needs to be addressed immediately. The client will need to take a reliever drug and seek emergency help immediately. Peak flow readings need to be measured twice a day. If a reading in the yellow zone occurs, the client should use the reliever drug and then measure the peak expiratory flow (PEF) again in a few minutes to determine whether the drug is working. Improvement in PEF should be seen. Clients need to check the PEF any time a reliever drug is used to determine the drug's effectiveness.
A nurse observes a patient using a dry powder inhaler device. The nurse should correct which patient actions? Select all that apply. a.The patient breathes into the inhaler. b. The patient performs deep and quick breathing. c. The patient shakes the medicine before using it. d. The patient holds the breath for more than 10 seconds. e. The patient inhales more than 1 puff with each inspiration.
a, c, e When using a dry powder inhaler, the patient should not breathe into the inhaler, because this affects the dosing. Inhaling more than one puff with each inspiration may cause waste of the medication. The patient should not shake the medicine before using it because it can alter the dosing. Deep and quick breathing is the proper technique, because it ensures that the medicine moves deep into the lungs. The patient should be encouraged to hold the breath beyond 10 seconds to help in penetration of the dry powder.
The nurse is preparing an education session for community planners concerning targeting resources to address increased rates of tuberculosis among community members. Which populations would the nurse include in the presentation? Select all that apply. a. Guards and food service workers in the nearby prison b. Elderly adults who attend activities at the local senior center c. Young adult men accessing services at a local homeless shelter d. Children who attend a private faith-based preschool 3 days a week e. Middle-aged adults who live in a low-income inner-city neighborhood f. Immigrants from Burma currently living with relatives while trying to find housing
a, c, e, f Individuals who work in long-term care settings, prisons, shelters such as homeless shelters, and hospitals are at higher risk of contracting tuberculosis. The homeless, residents of inner-city neighborhoods, those at poverty level, and individuals who are foreign-born also have a higher risk. Elderly individuals who attend activities at a senior center and young children who attend preschool at a private faith-based preschool would not necessarily have a higher risk for tuberculosis than the general population.
Indicate which assessment findings are considered abnormal for an adult patient. (Select all that apply.) A. Respiratory rate of 34 breaths per minute B. Diaphragmatic excursion is 1 cm C. Exhalation is twice as long as inhalation D. Vibrations can be palpated bilaterally on the patient's upper back when the patient says the number "99." E. Trachea is in the midline F. Suprasternal retractions are present during inhalation G. Loud, hollow sound is present on percussion of the right middle lobe H. Bronchial breath sounds are heard over the lateral areas of the left lung I. Absence of breath sounds bilaterally below the diaphragm J. The words "one, two, and three" are heard distinctly through the stethoscope on the patient's back when he or she whispers
a,b,f,h,j
As the home care nurse, you observe oral candidiasis in the patient with severe, chronic, airflow limitation. What information should you obtain from this patient? a. "How often are you using your steroid inhaler?" b. "Have you had a cold or other viral infection lately?" c. "When was the last time the oxygen tank was changed?" d. "Do you share a toothbrush with any members of your family?"
a.
During nasotracheal suctioning, the patient's heart rate changes from 78 to 48 beats/min. What is your best first action? a. Stop suctioning. b. Administer oxygen by mask at 2 L/min. c. Gently pinch the patient's cheek. d. Document the observation.
a.
The patient preparing to go home after a radical neck dissection for cancer is crying. When the nurse asks why he is crying, the patient writes, "I know I shouldn't cry because this surgery may well save my life, but I can't believe how changed my appearance is." What is the nurse's best response? a. "It is all right to cry. Mourning this loss is important in getting past this point." b. "You're right. It is silly to carry on like this when the surgery may cure you." c. "Would you like to talk to someone who also has had a laryngectomy?" d. "How have you coped with difficult situations in the past?"
a.
The patient tells you that he can stop several asthma attacks each day within a few minutes of their onset by using a short-acting beta-agonist inhaler and wants to know why he should bother to use regularly scheduled systemic drugs. What is your best response? a. "Frequent asthma attacks, even if they are halted relatively quickly, damage the bronchial tissues over time." b. "If asthma attacks are uncontrolled they lead to the eventual development of lung cancer and emphysema." c. "Using only short-acting beta agonists will lead to the development of drug resistance and then the drug won't work when you need it." d. "Beta-agonist inhaled drugs only treat the inflammatory aspects of asthma and do not help the inflammatory aspects of the disease."
a.
The patient with severe chronic bronchitis tells you that eating is difficult because he is so short of breath. What is your best response? a. "Try using your bronchodilator inhaler about 30 minutes before you plan to have a meal." b. "Avoid eating when you are short of breath so that you can use your energy for breathing." c. "Have your wife feed you solid foods, particularly avoiding those that cause you to have gas." d. "When you find eating solid food too difficult, just drink milk and milkshakes for the protein and calories."
a.
What intervention should you teach the patient with COPD to reduce the amount of stale air in his or her lungs? a. Using pursed-lip and abdominal breathing b. Avoiding dehydration by drinking at least 3 liters of fluid daily c. Interspersing planned rest and nap periods between periods of physical activity d. Maintaining himself or herself in a semisitting position, with the arms supported
a.
Which action should you teach a patient with asthma to perform in order to assess his or her response to the prescribed asthma medications? a. "Keep a daily symptom and intervention diary." b. "Measure your chest circumference every week." c. "Add up the total cost of your asthma medications for one month." d. "Use the proper technique and correct sequence when using a metered dose inhaler."
a.
Which clinical manifestation in a patient with pharyngitis alerts the nurse to the possibility of a bacterial infection? a. Fever of 101o F b. Difficulty swallowing c. Swollen lymph nodes d. Erythema of the pharynx
a.
Which intervention should the nurse suggest to assist drainage of material from the sinuses for a patient with a sinus infection? a. "Drink 10 or more glasses of liquid each day." b. "Do not keep your mouth closed while sneezing." c. "Avoid bending over or putting your head in a dependent position." d. "Take the antibiotic for the entire time it is prescribed, not just until you feel better.
a.
Which intervention should the nurse urge a patient with a cold to use to avoid spreading the infection to other family members? a. "Wash your hands after blowing your nose or sneezing." b. "Use a dishwasher or boiling water to clean all dishes and utensils you have used." c. "Have the other members of your family wear masks until all cold manifestations have subsided." d. "Humidify the air in your home with a humidifier or by running hot shower water to produce steam."
a.
Your 84-year-old patient has an SaO2 of 96% on room air. What is your best action? a. Document the finding as the only action. b. Verify the measurement. c. Notify the physician. d. Apply oxygen.
a.
A client returns to the unit fully awake after a bronchoscopy and biopsy. Which action is priority? a.Assess the presence of a gag reflex b. Provide ice chips as a comfort measure c. Encourage the client to cough frequently d. Advise the client to stay flat for several hours
a. Because of the administration of a local anesthetic during bronchoscopy, fluids and food should be withheld until the gag reflex returns to prevent aspiration. Ice chips must not be given until the gag reflex returns. Coughing should not be encouraged because it might initiate bleeding from the biopsy site. Lying flat will increase the risk for aspiration.
While assessing a patient with lung cancer, the nurse suspects that the patient has brain metastasis. Which finding in the patient supports the nurse's inference? a. Unsteady gait b. Muscle wasting c.Pleural effusions d. Edema of face and neck
a. A patient with lung cancer who has brain metastasis may have neurologic problems such as an unsteady gait. Muscle wasting is related to musculoskeletal problems, which are a late manifestation of lung cancer. Pleural effusions are respiratory system manifestations of lung cancer. Edema of the face and neck is observed in patients with superior vena cava syndrome.
An older client with shortness of breath is admitted to the hospital. The medical history reveals hypertension in the last year and a diagnosis of pneumonia three days ago. Which vital sign assessment would be seen as a sign that the client needs immediate medical attention? a. Oxygen Saturation: 89% b. Body temperature: 101°F c. Blood Pressure: 130/80 mmHg d. Respiratory rate: 26 beats/minute
a. An oxygen saturation less than 90% observed in a client with pneumonia indicates that the client is at risk of respiratory depression. Oxygen saturation would take priority in initiating the care. The client's body temperature indicates fever due to pneumonia, which should be considered secondary to the oxygen saturation problem. The blood pressure reading is normal. The increased respiratory rate may be due to fever, which would be considered secondary to the oxygen saturation problem.
A client has been admitted for chronic obstructive pulmonary disease (COPD) exacerbation secondary to an upper respiratory tract infection. The nurse should expect which findings when auscultating the client's breath sounds? a. Coarse crackles b. Prolonged inspiration c.Short, rapid inspiration d. Normal breath sounds
a. Coarse crackles and rhonchi most often are auscultated in COPD clients who have had an exacerbation. Clients will exhibit prolonged expiration, not prolonged inspiration. The client would not exhibit short, rapid inspiration or normal breath sounds with COPD.
A nurse is caring for a client with chronic obstructive pulmonary disease (COPD). Which clinical finding supports the nurse's suspicion that the client is developing cor pulmonale? a. Peripheral edema b.Productive coughing c.Twitching of the extremities d. Lethargy progressing to coma
a. Cor pulmonale [1] [2] is right ventricular failure caused by pulmonary congestion; edema results from increasing venous pressure. A productive cough is symptomatic of the original condition, COPD. Although twitching of the extremities and lethargy progressing to coma may be caused by alterations in oxygen and hydrogen ion levels and their effects on the central nervous system, it is the sign of peripheral edema that directly indicates increasing venous pressure secondary to cor pulmonale.
The nurse is teaching the client with chronic obstructive pulmonary disease (COPD) to use pursed-lip breathing (PLB). What is the rationale for the nurse's teaching? a. Prolonged exhalation to decrease air trapping b. Shortened inhalation to reduce bronchial swelling c. Increased respiratory rate to improve arterial oxygenation d. Decreased use of diaphragm to increase amount of inspired air
a. Pursed-lip breathing works to decrease dyspnea and the respiratory rate through prolonging exhalation and prevention of alveolar collapse. PLB does not increase the length of inhalation and does not increase the respiratory rate. Use of the diaphragm occurs with diaphragmatic, or abdominal, breathing.
A patient with lung cancer scheduled for a surgical resection received radiation therapy preoperatively. About which outcome does the nurse educate the patient after the radiation therapy? a. Reduction in the tumor mass b. Relief of dyspnea and hemoptysis c. Removal of lesions obstructing the airway d. Delay extension of the tumor into the airway lumen
a. Radiation therapy is used preoperatively before a surgical resection to reduce the tumor size. Radiation therapy relieves symptoms of dyspnea and hemoptysis in patients having bronchial obstructive tumors. The removal of lesions obstructing the airway is done using bronchoscopic laser therapy and photodynamic therapy. Airway stenting helps to delay the extension of tumors into the airway lumen.
Which factor places a conscious patient at risk for pneumonia? a. Difficulty swallowing medication b.Lying supine for two consecutive hours c.Effective postoperative pain management d. Adequate cough and deep breathing exercises
a. The patient who has difficulty swallowing needs assistance in eating, drinking, and taking medication to prevent aspiration. Difficulty swallowing increases risk of aspiration. Treating postoperative pain effectively provides comfort, permitting the patient to cough and deep breathe and achieve optimum mobility. Lying supine for two consecutive hours alone does not place an otherwise healthy patient at risk for pneumonia, but for the altered consciousness patient, repositioning should occur at least every two hours. Turning, coughing, and deep breathing exercises promote optimal oxygenation or perfusion and help prevent atelectasis.
A patient with asthma develops wheezing on the postanesthesia care unit. The nurse finds that the patient is tachypneic, has dyspnea, and has reduced oxygen saturation. How will the nurse prevent further pulmonary complications? a. Administer bronchodilators. b.Provide incentive spirometry. c. Encourage chest physical therapy. d. Provide nebulization of histamine vapors.
a. The presence of wheeze, tachypnea, and reduced oxygen saturation indicates bronchospasm. The use of bronchodilators relieves bronchospasm and promotes a patent airway. Incentive spirometry is useful in managing atelectasis when the airway is patent. Chest physical therapy is helpful to clear secretions from the respiratory tract. Histamine vapors aggravate bronchospasm and therefore should be avoided.
The patient has had several episodes of laryngitis following an upper respiratory infection. Which statement made by the patient indicates the need for clarification regarding the causes and treatment of acute laryngitis? a. "I knew I would get laryngitis this time because I cheered for hours at the ball game." b. "At the first hint of laryngitis, I whisper instead of talking in my regular voice." c. "I suck on throat lozenges to keep my mouth and throat from getting so dry." d. "When laryngitis starts, I quit smoking until all symptoms are gone."
b
Which observation indicates to you that your patient with COPD is effectively using interventions for airway clearance? a. The patient's cough is nonproductive. b. The oxygen saturation is consistently above 88%. c. The patient consistently uses "pursed-lip" breathing. d. The serum albumin level is within the normal range.
b
Which patient should the nurse caution to avoid taking over-the-counter decongestants for manifestations of a cold or flu? a. 25-year-old man with a latex allergy b. 45-year-old woman with hypertension c. 32-year-old woman who is taking oral contraceptives d. 65-year-old man who has had type 1 diabetes mellitus for 20 years
b
When caring for a patient with tuberculosis, what measures should the nurse instruct the patient to take to avoid the spread of infection? Select all that apply. a. Drink plenty of water and maintain an erect posture. b. Throw used tissues in a paper bag and dispose with the trash. c. Carefully wash hands after handling sputum and soiled tissues. d. a standard isolation mask when outside the patient's room. e. Cover the nose and mouth with a tissue while coughing and sneezing. f. Get out of bed and move freely about the hospital to keep up strength.
b, c, d, e In order to prevent the spread of infection, patients with tuberculosis should be encouraged to cover the nose and mouth with tissues while coughing and sneezing, to throw used tissues in a paper bag and dispose of them with the trash, to carefully wash hands after handling sputum and soiled tissues, and to wear a standard isolation mask while moving out of their room. Increasing the frequency of prolonged visits to other parts of the hospital is not advisable because it can increase the chances of infection spread; instead, such visits should be limited. Drinking plenty of water and maintaining erect posture have no effect on controlling infection.
The nurse is caring for a patient who is on mechanical ventilation. What findings suggest that the patient has ventilator-associated pneumonia? Select all that apply. a. Hypothermia b.Odorous sputum c.Crackles on auscultation d. Reduced white blood cell count e. Pulmonary infiltrates on chest x-ray
b, c, e Odorous sputum, crackles on auscultation, and pulmonary infiltrates noted on chest x-ray are all clinical manifestations which suggest that the patient has ventilator-associated pneumonia. Hyperthermia (fever), not hypothermia, and elevated white blood cell count are other manifestations of ventilator-associated pneumonia.
The 60-year-old woman with COPD tells you that she and her husband have not had sexual relations in 10 months because she is so fatigued. She indicates that she would like to again have sex with her husband. What is an appropriate intervention for this problem? a. Suggest that the patient try to make herself more attractive by losing weight. b. Suggest that she and her husband consider having sex in the morning or after a nap. c. Suggest that the patient and her husband have a glass or two of wine to increase her energy. d. Suggest that the patient ask her doctor for a prescription of medication to increase her metabolic rate.
b.
The patient diagnosed with moderate stage COPD says there is no sense in stopping smoking now because the damage is done. Which response is the best rationale for encouraging this patient to stop smoking? a. "The damage will be reversed." b. "The COPD will progress more slowly." c. "Your risk for asthma development, which would further reduce your lung function, will be decreased." d. "You will be less likely to lose excessive amounts of weight and will have a more normal appearance."
b.
The patient has broken ribs that penetrated through the skin as a result of a motor vehicle crash 3 days ago. The patient now complains of increased pain, shortness of breath, and fever. Which assessment finding alerts the nurse to the possibility of a pleural effusion and empyema? a. Wheezing on exhalation on the side with the broken ribs b. Absence of fremitus at and below the site of injury c. Crepitus of the skin around the site of injury d. Absence of gastric motility
b.
The patient is brought to the emergency department with severe facial trauma from a fist fight. What is the nurse's priority in caring for this patient? a. Assessing for manifestations of a fractured skull b. Assessing for a patent airway c. Controlling facial swelling d. Preserving vision
b.
The patient with bacterial pharyngitis and tonsillitis is allergic to penicillin. What antibiotic should the nurse be prepared to administer in place of penicillin? a. Amoxicillin (Amoxil) b. Erythromycin (E-Mycin) c. Cephalexin (Keflex) d. Tetracycline (Sumycin)
b.
Which clinical manifestation alerts you to the presence of hypoventilation when you are monitoring a patient with chronic lung disease and hypercarbia who is receiving oxygen therapy a. Coarse crackles and wheezes on auscultation b. Slow, shallow respirations c. Pulse oximetry of 90% d. Clubbing of the fingers
b.
Which conditions or factors in a 64-year-old man diagnosed with head and neck cancer are most likely to have contributed to this health problem? a. He quit school at age 16 and has worked in a butcher shop for over 40 years. b. He uses chewing tobacco and drinks beer daily. c. His father also had head and neck cancer. d. His hobby is oil painting.
b.
Which statement made by the patient undergoing radiation treatment for laryngeal cancer indicates the need for continued discussion regarding the effects of therapy? a. "I will avoid exposing my skin to sunlight during treatment." b. "I will purchase a wig so that my appearance will be close to normal." c. "I will rest my voice and communicate by writing for the next two months." d. "I will not shave until all the redness and peeling of the skin on my face and neck is gone."
b.
You are the only licensed health care professional assigned to a small medical-surgical unit with 12 beds. Two unlicensed assistive personnel are also working on this unit. Which of these four patients with respiratory problems should be assigned to you rather than to the unlicensed assistive personnel? a. 82-year-old woman receiving steroid therapy for pulmonary fibrosis whose pulse oximetry is 92% b. 35-year-old woman receiving intravenous aminophylline for asthma whose pulse oximetry is 92% and whose FEV1 is 50% of expected c. 55-year-old man with chronic obstructive lung disease whose pulse oximetry is 88% and who has the following arterial blood gas values: pH, 7.35; HCO3-, 36 mEq/L; PCO2, 65 mm Hg; PO2, 78 mm Hg d. 50-year-old man 2 days postoperative from a pneumonectomy for lung cancer whose pulse oximetry is 92% and whose chest tube is draining 200 mL/8-hour shift
b.
You observe that the 60-year-old patient's anteroposterior (AP) chest diameter is the same as her lateral chest diameter. What is your best next question in regard to this finding? a. No questions are needed regarding this normal finding. b. "Do you have any chronic breathing problems?" c. "How often do you perform aerobic exercise?" d. "What are your hobbies?"
b.
Which clinical observation should the nurse anticipate finding when assessing a client with a newly diagnosed case of early-stage active tuberculosis (TB)? a. Splenomegaly with lymphadenopathy b. Dry cough for more than 3 weeks c. Severe dyspnea with hemoptysis d. Headaches, nausea, and vomiting
b. A dry cough for more than 3 weeks is the clinical observation that the nurse should anticipate finding when assessing a client with a newly diagnosed case of early-stage TB. Splenomegaly, severe dyspnea, or severe headaches with vomiting can occur for different reasons during the later stages of TB. Splenomegaly with lymphadenopathy occurs with miliary TB, which is the widespread dissemination of TB bacteria throughout the blood stream. Severe dyspnea with hemoptysis also occurs at a later stage of active TB. Headaches, nausea, and vomiting are observed in TB meningitis, which happens when TB bacteria have migrated to other organs beyond the lungs (extrapulmonary TB).
The nurse is caring for a patient admitted with a diagnosis of chronic obstructive pulmonary disease (COPD) who has the following arterial blood gas results: pH 7.33, PaO2 47 mm Hg, PaCO2 60 mm Hg, HCO3 32 mEq/L, and O2 saturation of 92%. What interpretation of these results does the nurse report to the primary care provider? a. Fully compensated respiratory alkalosis b. Partially compensated respiratory acidosis c. Normal acid-base balance with hypoxemia d. Normal acid-base balance with hypercapnia
b. A low pH (normal 7.35-7.45) indicates acidosis. In the patient with a respiratory disease such as COPD, the patient retains carbon dioxide (normal 35-45 mm Hg), which acts as an acid in the body. For this reason, the patient has respiratory acidosis. The elevated HCO3 indicates a partial compensation for the elevated CO2.
When caring for a patient with chronic obstructive pulmonary disease (COPD), the nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after noting a weight loss of 30 lb. Which intervention should the nurse add to the plan of care for this patient? a. Prescribe fruits and fruit juices to be offered between meals b. Prescribe a high-calorie, high-protein diet with six small meals a day c. Teach the patient to use frozen meals at home that can be microwaved d. Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet
b. Because the patient with COPD needs to use greater energy to breathe, there often is decreased oral intake because of dyspnea. A full stomach also impairs the ability of the diaphragm to descend during inspiration, thus interfering with the work of breathing. For these reasons, the patient with COPD should eat six small meals per day, taking in a high-calorie, high-protein diet, with non-protein calories divided evenly between fat and carbohydrate. Prescribing fruits and fruit juices, teaching the patient to use frozen meals at home, and providing a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet will not increase the patient's caloric intake.
A client is admitted with a tentative diagnosis of pneumonia. On admission the client is not in respiratory distress, but later develops chest pain and a fever of 103° F (39.4° C). A productive cough produces rust-colored sputum. How should the nurse interpret these findings? a. Onset of pulmonary edema b. Expected course of pneumonia c. Presence of a pulmonary embolus d.Insidious onset of tuberculosis (TB)
b. Chest pain, fever, productive cough, and rust-colored sputum are cardinal signs of pneumonia [1] [2]. Chest pain results from excessive coughing; fever, increased sputum, and rust-colored sputum result from the infectious process. Dependent edema, respiratory distress, and crackles on auscultation of the lungs are associated with pulmonary edema. Although chest pain is expected with a pulmonary embolus, rust-colored sputum and a high fever are not. Pulmonary TB is associated with a low-grade fever, nonproductive or mucopurulent blood-tinged sputum, night sweats, and fatigue.
A nurse is caring for a client experiencing an acute episode of bronchial asthma. What should nursing interventions achieve? a. Curing the condition permanently b. Raising mucous secretions from the chest c. Limiting pulmonary secretions by decreasing fluid intake d. Convincing the client that the condition is emotionally based
b. In addition to dilation of bronchi, treatment is aimed at expectoration of mucus. Mucus interferes with gas exchange in the lungs. Curing the condition permanently is an unrealistic goal; asthma is a chronic illness. Increased fluid intake helps liquefy secretions. Asthma has a psychogenic factor, but this is not the only cause; it may occur as an allergic response to an antigen, such as dust.
The nurse determines that a patient is experiencing common adverse effects from the inhaled corticosteroid beclomethasone after what occurs? a. Hypertension and pulmonary edema b. Oropharyngeal candidiasis and hoarseness c. Elevation of blood glucose and calcium levels d. Adrenocortical dysfunction and hyperglycemia
b. Oropharyngeal candidiasis and hoarseness are common adverse effects from the use of inhaled corticosteroids because the medication can lead to overgrowth of organisms and local irritation if the patient does not rinse the mouth following each dose. Beclomethasone does not cause hypertension, pulmonary edema, elevated calcium levels or blood glucose levels, or adrenocortical dysfunction.
Which type of primary lung cancer presents with a very rapid growth of cancer cells? a.Adenocarcinoma b. Small cell carcinoma c.Large cell carcinoma d.Squamous cell carcinoma
b. Small cell carcinoma has a very rapid growth rate and is the most malignant form of lung cancer. Adenocarcinoma has a moderate growth rate and is the most common form of lung cancer in people who have not smoked. Squamous cell carcinoma has a very slow growth rate and has a central location. Large cell carcinoma (undifferentiated carcinoma) is composed of highly metastatic large cells that arise from the bronchi.
The nurse is explaining the pathophysiology of asthma to a patient. Which is the most appropriate explanation? a. "An acid-base imbalance causes bronchoconstriction and edema of the airways." b."Inflammation causes bronchoconstriction, hyperreactivity, and edema of the airways." c."Inflammation causes bronchodilation, hyperreactivity, and pressure of the airways." d. "An immune response causes bronchodilation, hyperreactivity, and edema of the airways."
b. The primary pathophysiologic process in asthma is persistent but variable inflammation of the airways. The airflow is limited because the inflammation results in bronchoconstriction, airway hyperresponsiveness (hyperreactivity), and edema of the airways. Exposure to allergens or irritants initiates the inflammatory cascade. An immune response does not trigger asthma. Inflammation causes edema, not pressure, of the airways. Acid-base imbalances do not trigger asthma.
While caring for a client with asthma, the nurse auscultates a bilateral high-pitched, continuous whistling sound in the anterior lung fields. What finding does the nurse document in the medical record? a. Crackles b. Wheezes c. Rhonchus d. Pleural friction rub
b. Wheezing, an adventitious breath sound, is a high-pitched continuous whistling that does not clear with coughing. Crackles are popping, discontinuous sounds caused by air moving into previously deflated airways. Rhonchus is a lower-pitched, coarse, continuous snoring sound that arises from the large airways. Pleural friction rub is a loud, rough, grating sound produced by inflammation of the pleural lining.
The patient, a 63-year-old man who has smoked 2 packs of cigarettes per day for 45 years, has just had his brother die of small cell lung cancer. Knowing that cancer is easier to cure in the early stages, the patient asks you about early symptoms of lung cancer. What is your best response? a. "There are no early symptoms of lung cancer." b. "Early symptoms of lung cancer include bloody sputum and nagging chest pain." c. "Early symptoms are nonspecific, consisting of cough and shortness of breath on moderate exertion." d. "Wheezing on exhalation should always be considered a positive sign of lung cancer until proven otherwise."
c
What is the priority psychosocial nursing diagnosis for a person with moderate COPD who lives in his or her own home? a. Disturbed Body Image related to presence of a barrel chest b. Impaired Home Maintenance related to activity intolerance c. Social Isolation related to embarrassment from chronic coughing d. Ineffective Role Performance related to change in physical condition
c
The 95-year-old nursing home resident has a productive cough, fever, chills, and a history of night sweats. The patient's PPD test is negative. What is the nurse's best action related to infection prevention? a. Use standard precautions alone because the patient does not have tuberculosis. b. Use standard precautions and airborne precautions because the patient has tuberculosis. c. Use standard precautions and airborne precautions until a chest x-ray shows the patient does not have tuberculosis. d. Use airborne precautions alone because the patient is taking penicillin therapy for another respiratory infection.
c.
The patient tells you that he usually expectorates about 2 ounces of thin, clear, colorless sputum each day, mostly in the morning after getting out of bed. What is your best action? a. Ask the patient to produce some sputum now into a clean specimen container for laboratory analysis. b. Obtain a sterile specimen of the sputum for culture. c. Document the report as the only action. d. Notify the physician.
c.
The patient who began having manifestations of a cold yesterday asks if she should babysit for her two young grandchildren this evening. What is the nurse's best response? a. "Yes, if your grandchildren are up to date on their immunizations, they will be protected against your cold." b. "Yes, you were only contagious for the first 24 hours after you began having manifestations of a cold and are now no longer contagious." c. "No, the usual period for being able to spread a cold is during the first 2 or 3 days after you start having manifestations." d. "No, you will be considered contagious until all manifestations of the cold have been gone for at least 24 hours."
c.
What health promotion activity should the nurse stress to the patient who has xerostomia as a result of radiation therapy for head and neck cancer? a. Carrying a medical alert card b. Increasing carbohydrate and fat intake c. Having a dental examination twice per year d. Using only water-soluble lubricants on the irradi
c.
What problem would result from a swollen epiglottis? a.The airway would be unprotected during swallowing, increasing the risk for aspiration. b.The vocal cords would be stretched, causing the voice to be deeper. c.The airway would be obstructed, causing a decrease in ventilation. d.Swallowing would be impossible.
c.
Which action should you take to prevent hypoxia during nasotracheal suctioning? a. Measuring pulse oximetry throughout the procedure b. Inserting the suction catheter through the vocal cords when the patient exhales c. Administering 100% oxygen by manual resuscitation bag before initiating suctioning d. Removing the suction tube from the nasopharynx as soon as the patient begins to cough
c.
Which assessment finding in a patient who has been medicated during an asthma attack indicates to you that the therapy should be modified? a. Peak expiratory rate flow 10% below expected value b. Presence of bilateral tactile fremitus c. Suprasternal retraction on inhalation d. Trachea at the midline
c.
Which assessment finding in a patient with severe dyspnea indicates to you that the respiratory problem is chronic? a. Wheezing on exhalation b. Productive cough c. Clubbed fingers d. Cyanosis
c.
Which blood gas value indicates that the patient is experiencing hypercarbia? a. pH = 7.33 b. Bicarbonate = 20 mEq/L c. PaCO2 = 60 mm Hg d. PaO2 = 80 mm Hg
c.
Which clinical manifestation in a patient who smokes two packs of cigarettes per day should be explored further for head and neck cancer? a. Unplanned weight gain of 15 pounds b. Decreased sense of taste c. Difficulty swallowing d. Persistent bad breath
c.
Which clinical manifestation in a patient with chronic bronchitis indicates to you a worsening of the patient's respiratory condition? a. Fatigue b. Cachexia c. Confusion d. Slow capillary refill
c.
Which diagnostic indicator confirms the presence of active tuberculosis? a. Positive PPD test b. The presence of calcified lesions on chest x-ray c. The presence of M. tuberculosis in a sputum culture d. The combined clinical manifestations of weight loss, night sweats, fever, and cough productive of mucopurulent bloody sputum
c.
Which drug is more commonly used as therapy for COPD than as therapy for asthma? a. Theophylline b. Montelukast c. Guaifenesin d. Salmeterol
c.
Which patient is at greatest risk for development of obstructive sleep apnea a. 28-year-old woman who is eight months pregnant b. 38-year-old man with gastroesophageal reflux disease c. 48-year-old woman who is approximately 50 pounds overweight d. 58-year-old man with diabetes mellitus and a history of sinus infections
c.
Which statement made by a patient prescribed to use a DPI indicates the need for more instruction? a. "I will not exhale into the inhaler." b. "I will keep the inhaler in the drawer of my bedroom dresser." c. "I will wash the inhaler mouthpiece daily with soap and water." d. "I will inhale twice as hard through this inhaler as I do with my aerosol inhaler."
c.
A nurse receives a call from the emergency department about a client with tuberculosis (TB) who will be admitted to the medical unit. Which precaution should the nurse take? a. Put on a gown when entering the room b. Place the client with another client who has TB c. Wear a particulate respirator when caring for the client d. Don a surgical mask with a face shield when entering the room
c. A high-particulate filtration mask that meets Centers for Disease Control (CDC) performance criteria (Canada: Public Health Agency of Canada [2013] Canadian Tuberculosis Standards, 7th edition) for a tuberculosis respirator must be worn to protect healthcare providers from exposure to the Mycobacterium tuberculosis organism. Airborne transmission-based precautions do not require a gown unless contact with respiratory secretions is anticipated. The client should be placed in a private room with negative pressure and multiple full air exchanges per hour vented to the outside environment. A surgical mask with a face shield is inadequate to prevent transmission of the tuberculosis microorganism.
A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and PCO2 of 60 mm Hg. These blood gases require nursing attention because they indicate which condition? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis
c. The normal blood pH range is 7.35 to 7.45; therefore, a blood pH of 7.25 indicates acidosis. The parameter for respiratory function is CO2 and the acceptable range of arterial PCO2 is 35 to 45 mm Hg; therefore, 60 mm Hg is elevated, resulting in respiratory acidosis. HCO3 is the parameter for metabolic functions. A pH of 7.25 is acidic, indicating acidosis and not alkalosis.
A client with asthma is being taught how to use a peak flow meter to monitor how well the asthma is being controlled. What should the nurse instruct the client to do? a. Perform the procedure once in the morning and once at night. b. Move the trunk to an upright position and then exhale while bending over. c. Inhale completely and then blow out as hard and as fast as possible through the mouthpiece. d. Place the mouthpiece between the lips and in front of the teeth before starting the procedure.
c. A peak flow meter measures the peak expiratory flow rate, the maximum flow of air that can be forcefully exhaled in one second; this monitors the pulmonary status of a client with asthma. The peak flow measurement should be done daily in the morning before the administration of medication or when experiencing dyspnea. The client should be standing. Placing the mouthpiece between the lips and in front of the teeth before starting the procedure will interfere with an accurate test; the mouthpiece should be in the mouth between the teeth with the lips creating a seal around the mouthpiece.
To promote airway clearance in a patient with pneumonia and asthma, the nurse instructs the patient to perform which action? a. Perform pursed-lip breathing b. Wear supplemental oxygen at all times c. Sit upright while using the flutter device d. Use the incentive spirometer 10 times per hour
c. The flutter device is used to increase mucus production to promote airway clearance and gas exchange; it should be used while the patient is in an upright position. Supplemental oxygen may not be indicated depending on the oxygen saturation level. Pursed-lip breathing and the incentive spirometer will not promote airway clearance.
A patient has a chest tube inserted to treat a spontaneous pneumothorax. Which observation causes the nurse to conclude that the water-seal chamber of the closed chest drainage system is functioning properly? a. Gentle bubbling in the suction chamber b. Patient tolerating mild shortness of breath c. Water-seal chamber level fluctuating with respirations d. The presence of bloody drainage in the water-seal chamber
c. The water-seal chamber level fluctuates with respirations as a result of the restoration of negative pressure within the thoracic cavity. Gentle bubbling in the suction chamber indicates a possible air leak. New-onset of shortness of breath in a patient with a chest tube requires further assessment. The water-seal chamber should not contain blood; this finding indicates that the chest tube drainage system may have been knocked onto its side and should be replaced.
A nurse is reading the PPD test on the left arm of an inpatient patient who was injected with the test material exactly 48 hours ago. The test area has a 4-mm diameter area of induration. What is the nurse's best action? a. Institute airborne infection precautions immediately. b. Document the observation as the only action. c. Retest the patient on the opposite arm. d. Re-examine the test site at 72 hours.
d
A patient has all of the following family and personal factors. Which one greatly increases the risk for the patient to develop respiratory problems? a. The patient has long-standing hypertension. b. The patient's father died of lung cancer at age 82. c. The patient's sister has a child with cystic fibrosis. d. The patient has a deficiency of alpha1-antitrypsin
d
The patient has a peritonsillar abscess. What is the priority instruction the nurse should provide to this patient? a. "If you notice an enlarged lymph node on the same side of your neck as the abscess, call the doctor." b. "Stay home from work or school until your temperature has been normal for 24 hours." c. "You may gargle with warm water that has a teaspoon of salt in it as often as you like." d. "Take the antibiotic for the entire time it is prescribed, not just until you feel better."
d.
The patient is a 42-year-old man recently diagnosed with new-onset asthma. What specific personal/demographic information should you obtain related to this diagnosis? a. Previous diagnosis of pneumonia or tuberculosis b. Known allergies and hypersensitivities c. Nutritional intake and diet history d. Occupation and hobbies
d.
The patient with tuberculosis asks his nurse when he will be considered noninfectious. What is the nurse's best response? a. "When your PPD test is negative." b. "When your chest x-ray shows resolution of the lesions." c. "When you have been on the medication at least 6 weeks." d. "When you have three negative sputum cultures in a row.
d.
What assessment finding would you expect to find as a result of increased residual volume in a patient who has extensive, long-term chronic airflow limitation? a. Copious amounts of thick sputum b. Clubbed fingers c. Hypercarbia d. Barrel chest
d.
Which technique should you teach the patient with emphysema to use as exercise conditioning for pulmonary rehabilitation? a. Exercising only in the standing position b. Holding his or her breath between sets of exercises c. Keeping his or her arms above the head while exercising d. Breathing against a set resistance for 5 minutes 3 times/day
d.
A nurse is caring for a client with a pneumothorax who has a chest tube in place with a closed drainage system. Which of these actions by the nurse is correct? a. Strip the chest tube periodically. b. Administer the prescribed cough suppressant at the scheduled times. c. Empty and measure the drainage in the collection chamber each shift. d.Keep the drainage system lower than the level of the client's chest.
d. The drainage system is kept below the chest to allow gravity to drain the pleural space. The chest tube should not be stripped because this action can cause negative pressure and damage lung tissue. Cough suppressants are not indicated because coughing and deep breathing are encouraged to help reexpand the lung. The closed system is not entered for emptying; when full, the entire device is replaced.
A client has a chest tube for a pneumothorax. The nurse finds the client in respiratory difficulty, with the chest tube separated from the drainage system. What should the nurse do? a. Obtain a new sterile drainage system. b.Use two clamps to close the drainage tube. c. Place the client in the high-Fowler position. d. Reconnect the client's tube to the drainage system.
d. To prevent further possibility of pneumothorax, the nurse should reconnect the tube immediately. Obtaining a new sterile drainage system is unnecessary. Clamping the tube is appropriate when changing a broken drainage system or when checking for an air leak. The high-Fowler position is appropriate for a client in respiratory distress, but it does not remedy the problem.
A nurse is teaching a client with a diagnosis of pulmonary tuberculosis about recovery after discharge. What is the most important intervention for the nurse to include in this plan? a. Ensuring sufficient rest b. Changing lifestyle routines c. Breathing clean outdoor air d.Taking medications as prescribed
d. Tubercle bacilli are particularly resistant to treatment and can remain dormant for long periods. Drugs must be taken consistently, or more drug-resistant forms may recolonize and flourish. Although a balance between activity and rest is desirable, it is not the priority. A change in lifestyle is not necessary. Although clean, fresh air is desirable, it is not the priority.
A client comes to the emergency department reporting chest pain and difficulty breathing. A chest x-ray reveals a pneumothorax. Which finding should the nurse expect to identify when assessing the client? a. Distended neck veins b. Paradoxical respirations c. Increasing amounts of purulent sputum d. Absence of breath sounds over the affected area
d. When the lung is collapsed, air is not moving into and out of the area, and therefore breath sounds are absent. Distended neck veins are associated with failure of the right side of the heart and can occur with a mediastinal shift, but there is no evidence of either. Paradoxical respirations occur with flail chest, not pneumothorax. Purulent sputum is a sign of infection, not pneumothorax.
A patient experiencing an acute asthma exacerbation has received a bronchodilator and supplemental oxygen. Which treatment should the nurse anticipate if the patient's condition remains unchanged? a. Chest x-ray b. Peak flow measurements c. Intravenous (IV) antibiotics d. Intravenous corticosteroids
d. Corticosteroids are antiinflammatories that are effective in treating respiratory distress caused by bronchoconstriction. The patient would be given this medication as an IV push medication. Chest x-ray is not a treatment of an asthma exacerbation. IV antibiotics are not indicated in the absence of infection. Peak flow measurements can measure airflow, but will not improve the patient's condition.
The nurse assesses a client with emphysema. The nurse expects to find which sign of chronic obstructive pulmonary disease (COPD)? a. Increased breath sounds b. Atrophic accessory muscles c. Shortened expiratory phase of the respiratory cycle d. Chest with an increased anteroposterior (AP) diameter
d. In a client with emphysema, there is an increased AP diameter (barrel chest) because of air trapping and enlargement of the lungs with a loss of recoil ability. Decreased breath sounds, not increased, result from reduced airflow, pleural effusion, and destruction of lung tissue. There is enlargement of accessory muscles that are used during the expiratory phase to help force air out of the lungs. There is an increased expiratory phase of the respiratory cycle because of entrapment of air and collapse of airways.
A patient with asthma is prescribed beclomethasone and albuterol as two metered dose inhalers. Which instruction is the most effective method for administering these medications? a. Give beclomethasone 5 minutes before albuterol. b. Encourage coughing and deep breathing. c. Tell the patient to use a hand-held nebulizer. d.Use albuterol 2 minutes before beclomethasone.
d. The short-acting bronchodilator (albuterol) should be used first to open the airway before using the corticosteroid inhaler (beclomethasone). It takes albuterol about 1 to 3 minutes to open the airway. Coughing and deep breathing is certainly encouraged to clear any secretions that are obstructing the airway but this is not the most effective way to administer beclomethasone and albuterol. The patient has not been prescribed a hand-held nebulizer.
A client has chronic obstructive pulmonary disease (COPD). To decrease the risk of CO2 intoxication (CO2 narcosis), what should the nurse do? a. Initiate pulmonary hygiene to clear air passages of trapped mucus b. Instruct to deep breathe slowly with inhalation longer than exhalation c. Encourage continuous rapid panting to promote respiratory exchange d. Administer oxygen at a low concentration to maintain respiratory drive
d. With chronically high levels of carbon dioxide it is believed that decreased oxygen levels become the stimulus to breathe; high oxygen administration negates this mechanism. Initiating pulmonary hygiene to clear air passages of trapped mucus is an appropriate intervention, but is not directly related to CO2 intoxication (CO2 narcosis). Encouraging continuous rapid panting to promote respiratory exchange will not bring oxygen into the alveoli for exchange; nor will it adequately remove carbon dioxide because it will increase bronchiolar obstruction. Inhalation should be of regular depth, and expiration should be prolonged to prevent carbon dioxide trapping (air trapping).
The nurse provides care to a trauma victim. Which clinical manifestation most suggests a pneumothorax? a. inspiratory crackles b. Pronounced crackles c. Dullness on percussion c.Absence of breath sounds
d. A pneumothorax indicates that one of the lungs has collapsed and is not functioning. On auscultation no sounds of air movement will be heard. Because no air movement occurs with a pneumothorax, no breath sounds, including crackles, will be heard. Dullness may be a finding on percussion over the area of the pneumothorax, but an absence of breath sounds is the definitive finding.
What causes a risk of impaired gas exchange in a patient with dyspnea due to a rib fracture? a. Anorexia b. Hemoptysis c. Cystic fibrosis d. Smaller tidal volume
d. Dyspnea associated with rib fracture may limit diaphragm or chest wall movements and cause the patient to breathe smaller tidal volumes. As a result, the lungs do not fully inflate and gas exchange is impaired. Anorexia is an eating disorder characterized by weight loss. It is common in patients with chronic obstructive pulmonary disease and lung cancer. Hemoptysis is the act of coughing up blood or blood-stained mucus from the bronchi, trachea, larynx, or lungs. In cases of cystic fibrosis, cilia are often destroyed, resulting in impaired secretion clearance, a chronic colonization of bacteria, and cough.
A client is admitted to the hospital with a diagnosis of laryngeal cancer. What is a common early sign of laryngeal cancer for which the nurse should assess in this client? a. Aphasia b. Dyspnea c. Dysphagia d. Hoarseness
d. Hoarseness [1] [2] is caused by the inability of the vocal cords to move adequately during speech when a tumor exists. Aphasia refers to an expressive or receptive communication deficit as a result of cerebral disease; it is not related to laryngeal cancer. Dyspnea is a late, not early, adaptation that occurs with laryngeal cancer when a tumor is large enough to obstruct air flow. Dysphagia is a late, not early, adaptation that occurs when the tumor is large enough to compress the esophagus.
Before discharge, the nurse discusses activity levels with a patient with chronic obstructive pulmonary disease (COPD) and pneumonia. Which exercise goal is most appropriate once the patient is recovered fully from this episode of illness? a. Slight increase in activity over the current level b. Limitation of exercise to activities of daily living to conserve energy c. Swimming for 10 minutes/day, gradually increasing to 30 minutes/day d. Walking for 20 minutes/day, keeping the pulse rate less than 130 beats/minute
d. The patient will benefit from mild aerobic exercise that does not stress the cardiorespiratory system. The patient should be encouraged to walk for 20 minutes/day, keeping the pulse rate less than 75% to 80% of maximum heart rate (220 - patient's age).
A client is admitted with possible tuberculosis. To make a definitive diagnosis, the nurse expects which diagnostic test to be prescribed? a. Chest x-ray film b. Tuberculin skin test c. Pulmonary function test d. Sputum test for acid-fast bacilli
d. When the tubercle bacilli are stained with an acid, they turn red and are not decolorized by an acid-alcohol wash; they are acid fast. The rods are visible upon microscopic examination. Chest x-ray film reflects pulmonary status but does not identify the organism if a lesion is found. Tuberculin skin test indicates the presence of antibodies but is not diagnostic of the disease; it just means the client has been exposed. Pulmonary function test reflects pulmonary status but does not identify the organism if a lesion is found.
