Powerpoint Questions for Chapter 27 & 28

A physician orders NS at 125 ml/hr for a client with dehydration and pneumonia. How many liters of solution with the client receive during an 8 hour shift? 1. 1000 2. 100 3. 1 4. 12500

ANS: 1.

Which effect can kyphoscoliosis have on lung function? 1. Improves lung expansion 2. Obstructs lung deflation 3. Reduces alveolar compression during expiration 4. Restricts lung expansion

ANS: 4.

A 20 year old client is being treated for pneumonia. He has a persistent cough and of severe pain on coughing. What type of instruction should be given to help the client reduce the discomfort he's having? 1. Hold in your cough as much as possible 2. Place the head of your bed flat to help with coughing 3. Restrict fluids to help decrease the amount of sputum 4. Splint your chest wall with a pillow for comfort

ANS: 4.

A nurse is teaching a client who has tuberculosis and is to start combination drug therapy. Which of the following medications should the nurse plan to administer? (Select all that apply.) •1) Rifampin •2) Isoniazid •3) Acyclovir •4) Pyrazinamide •5) Montelukast

ANS: 1, 2, 4 •Rifampin is correct. A client who has tuberculosis should take rifampin to kill slower growing micro-organisms. The nurse should instruct the client to avoid drinking alcohol, to expect body secretions to have a reddish-orange tinge, and to report a yellow tinge to the skin or whites of the eyes.Isoniazid is correct. A client who has tuberculosis should take isoniazid to kill actively growing mycobacteria. The nurse should instruct the client to take the medication on an empty stomach and to take a daily multiple vitamin.Acyclovir is incorrect. A client should take acyclovir treat a viral infection, such as herpes simplex virus and herpes zoster.Pyrazinamide is correct. A client who has tuberculosis usually takes pyrazinamide for the first 12 months of therapy and can shorten the entire course of therapy to 6 months. The nurse should instruct the client to drink at least 240 mL (8 oz) of fluid when taking the medication and to protect himself from the sun with cotton clothing and sunscreen.Montelukast is incorrect. A client should take montelukast to manage chronic asthma, seasonal allergic rhinitis, or for prophylaxis of bronchospasms.

A nurse in a provider's office is assessing a client. The nurse should identify that which of the following findings are manifestations of pulmonary tuberculosis? (Select all that apply) •1) Night sweats •2) Low-grade fever •3) Weight gain •4) Flushed cheeks •5) Blood in the sputum

ANS: 1, 2, 5 •Night sweats is correct. Night sweats are a manifestation of tuberculosis. •Low-grade fever is correct. Low-grade fever is a manifestation of tuberculosis. •Weight gain is incorrect. Weight loss, not weight gain, is a manifestation of tuberculosis. •Flushed cheeks is incorrect. Flushed cheeks are a manifestation of pneumonia, not tuberculosis. •Blood in the sputum is correct. Blood-streaked sputum is a manifestation of tuberculosis.

An elderly client with pneumonia may appear with which symptoms first? 1. Altered mental status and dehydration 2. Fever and chills 3. Hemoptysis and dyspnea 4. Pleuritic chest pain and cough

ANS: 1.

Which intervention to prevent pulmonary embolism after lower extremity surgery is the best? 1. Early ambulation 2. Frequent cxr to find a PE 3. Frequent lower extremity scans 4. Intubation of the client

ANS: 1.

Which respiratory disorder is most common in the first 24 to 48 hours after surgery? 1. Atelectasis 2. Bronchitis 3. Pneumonia 4. Pneumothorax

ANS: 1.

A nurse is caring for a client who has tuberculosis and new prescriptions for rifampin and pyrazinamide. Which of the following laboratory tests should the nurse instruct the client will be required while on this medication regimen? •1) Liver function tests •2) Gallbladder studies •3) Thyroid function studies •4) Blood glucose levels

ANS: 1. •Answer Rationale: •Pyrazinamide and rifampin can both cause hepatotoxicity, thus the provider will monitor liver function regularly.

A nurse is caring for a client who is hospitalized with active pulmonary tuberculosis and is started on ethambutol therapy. The nurse should understand that which of the following should be monitored? •1) Visual acuity •2) Skin color •3) Urine output •4) Cardiac rhythm

ANS: 1. •A significant adverse effect of ethambutol is optic neuritis, vision loss, and loss of color discrimination, especially red and green. Baseline vision testing should be performed before use, and visual acuity monitored at regular intervals.

The nurse is caring for a postoperative client who has a chest tube connected to suction and a water seal drainage system. Which of the following indicates to the nurse that the chest tube is functioning properly? •1) Fluctuation of the fluid level within the water seal chamber •2) Absence of fluid in the drainage tubing •3) Continuous bubbling within the water seal chamber •4) Equal amounts of fluid drainage in each collection chamber

ANS: 1. •Fluctuation of fluid within the water seal chamber occurs with inspiration and expiration until the client's lungs have re-expanded or the system is occluded. •Chest tube systems drain both air and blood from the pleural space. If no fluid drainage is present in the tubing and collection chamber, there may be an obstruction.

A nurse is caring for a client who has a three-chamber closed chest tube system. Which of the following actions should the nurse take after noticing a rise in the water seal chamber with client inspiration? 1) Continue to monitor the client. 2) Immediately notify the provider. 3) Reposition the client toward the left side. 4) Clamp the chest tube near the water seal.

ANS: 1. •The fluid in the water seal chamber rises 2 to 4 inches during inhalation and falls during exhalation. This is a process called tidaling. An absence of tidaling might indicate a fully expanded lung or an obstruction in the chest tube.

A nurse is caring for a client who is 12 hr postoperative and has a chest tube to a disposable water-seal drainage system with suction. The nurse should intervene for which of the following observations? •1) Constant bubbling in the suction-control chamber •2) Continuous bubbling in the water-seal chamber •3) Bloody drainage in the collection chamber •4) Fluid-level fluctuations in the water-seal chamber

ANS: 2.

The nurse is conducting a class for family members of clients diagnosed with TB. Which of the following should the nurse teach family members regarding transmission of the disease? 1. It is transmitted by sexual conduct 2. It is transmitted by contaminated needles 3. It is transmitted through contaminated eating utensils 4. It is transmitted by droplets exhaled from an infected person

ANS: 4.

The nurse is teaching a client about lung cancer. The client indicates an understanding of the number one cause of lung cancer when makes which of the following responses? 1. Genetics 2. Occupational exposures 3. Smoking a pipe 4. Smoking cigarettes

ANS: 4.

A nurse is preparing for the admission of client who has suspected active tuberculosis. Which of the following precautions should the nurse plan to implement to safely care for this client? •1) Have staff and visitors wear gowns, masks, and gloves while in the client's room. •2) Place the client in a private room with a special ventilation system. •3) Assign the client to a room with other clients who require droplet precautions. •4) Modify the protocol for donning and removing personal protective equipment before entering or leaving the client's room.

ANS: 2. •Answer Rationale: •Clients who have active tuberculosis should be assigned to private rooms with negative-pressure airflow via HEPA filtration systems. In these rooms, the air is not returned to the inside ventilation system but is filtered and exhausted directly to the outside.

A nurse is caring for a client who has active pulmonary tuberculosis (TB). The client requires airborne precautions and is receiving multidrug therapy. Which of the following precautions should the nurse take to transport the client safely to the radiology department for a chest x-ray? •1) Ask the x-ray technician to come to the client's room to obtain a portable x-ray. •2) Have the client wear a mask. •3) Notify the x-ray department that the client requires airborne precautions. •4) Wear a filtration mask and gloves during transport.

ANS: 2. •When a client who has a communicable disease must leave his room, it is important to protect everyone with whom the client comes in contact. Having the client wear a mask protects others from airborne particles should the client cough.

A nurse is caring for a client who has a chest tube connected to a closed drainage system and needs to be transported to the x-ray department. Which of the following actions should the nurse take? •1) Clamp the chest tube prior to transferring the client to a wheelchair. •2) Disconnect the chest tube from the drainage system during transport. •3) Keep the drainage system below the level of the client's chest at all times. •4) Empty the collection chamber prior to transport.

ANS: 3 •Clamping the tube can lead to a tension pneumothorax (collapse of the lung) due to increased intrathoracic pressure from gas and fluid that cannot be drained from the pleural space. •The chest tube should not be disconnected from the drainage system. •During transport, the drainage system should be kept below the level of the client's chest to prevent air and drainage fluid from re-entering the thoracic cavity. •.Emptying the collection chamber prior to transport is unnecessary.

A nurse is instructing a client who is newly diagnosed with pulmonary tuberculosis (TB) about the use of antitubercular medications. Which of the following information should the nurse include in the teaching? •1) Medications will need to be taken for the rest of the client's life, even if the client feels better. •2) Medications will need to be taken until the Mantoux test is negative. •3) A typical course of treatment involves 6 to 9 months of consistent medication use. •4) The client's family will also need to take medications to prevent infection.

ANS: 3 •Pulmonary TB is a contagious bacterial infection caused by Mycobacterium tuberculosis. Active TB is usually treated with the simultaneous administration of a combination of medications to which the organisms are susceptible. Such therapy is continued until the disease is controlled. A 6- to 9-month regimen consisting of two, and often four, different medications is used. The client should not drink alcohol during this time.

A 165 lb client with pulmonary embolus is ordered to receive heparin 20 units/kg/hr by IV infusion. How many units of heparin should he receive each hour? 1. 1,000 2. 1,200 3. 1,500 4. 1,700

ANS: 3.

A 19 year old client went to a party, took some pills and drank beer. He's brought to the ED because he won't wake up. When assessing him, the nurse should expect to find which reaction? 1. Hyper reflexive reflexes 2. Muscle spasms 3. Shallow respirations 4. Tachypnea

ANS: 3.

A client with a chest tube has accidentally removed it. What action should the nurse perform first? 1. Position the client on his left side 2. Position the client on his right side 3. Apply an occlusive dressing over the site 4. Reinsert the chest tube that fell out

ANS: 3.

After a right lower lobectomy a client returns to her room with a chest tube in place. The nurse formulates a diagnosis of impaired gas exchange r/t lung surgery. Which outcome is most appropriate? 1. The client will sit upright, leaning slightly forward 2. The client will request pain medication as needed 3. The client will maintain a pulse oximetry level above 93% 4. The client will be pain free

ANS: 3.

Pulse oximetry gives what type of information about a client? 1. Amount of carbon dioxide in the blood 2. Amount of oxygen in the blood 3. Percentage of hemoglobin carrying oxygen 4. Respiratory rate

ANS: 3.

What effect does hemoglobin level have on oxygen status? 1. It has no effect 2. More hemoglobin reduces the client's respiratory rate 3. Low hemoglobin levels cause reduced oxygen carrying capacity 4. Low hgb levels cause increased oxygen carrying capacity

ANS: 3.

What needle is appropriate for a TB skin test? 1. 5/8" to ½" 25G to 27G needle 2. 1" to 3" 20G to 25G needle 3. ½" to 3/8" 26G or 27G needle 4. 1" 20G needle

ANS: 3.

Which treatment should a nurse expect for a client with a pneumothorax? 1. Antibiotics 2. Bronchodilators 3. Chest tube placement 4. Hyperbaric chamber

ANS: 3.

A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. Which of the following actions should the nurse take to reduce the risk of ventilator-associated pneumonia? •1) Position the head of the client's bed in the flat position. •2) Turn the client every 4 hr. •3) Brush the client's teeth with a suction toothbrush every 12 hr. •4) Provide humidity by maintaining moisture within the ventilator tubing.

ANS: 3. •The nurse should brush the client's teeth every 12 hr and rinse the client's mouth with an antimicrobial rinse to reduce the growth of bacteria.

A nurse is applying wrist restraints to a client who is confused and attempting to pull out a chest tube. Which of the following actions should the nurse taking when using restraints? •1) Ensure that 1 finger breadth of space is between the client's wrists and the restraint. •2) Secure the restraints to the side rails. •3) Remove the restraint to check integrity of the skin every 4 hr. •4) Tie the restraint using a quick release knot.

ANS: 4 •The nurse should use a half bow (clove hitch, quick release) knot that does not does not tighten and can be removed quickly.

Which measure can reduce or prevent the incidence of atelectasis in a postoperative client? 1. Chest physiotherapy 2. Mechanical ventilation 3. Reducing oxygen requirements 4. Use of an incentive spirometer

ANS: 4.

A nurse in a community health center is assessing the results of a tuberculin skin test she performed for a client. Which of the following results indicates exposure to and a possible infection with tuberculosis (TB)? •1) 4 mm erythema •2) 5 mm induration •3) 10 mm wheal •4) 15 mm induration

ANS: 4. Answer Rationale: A positive reaction to a tuberculin skin test is an induration (a hardened area) that is 10 mm or greater in diameter. The nurse should measure the area of induration, not any accompanying erythema or swelling.

A nurse is teaching a client who has tuberculosis and is to start medication therapy with isoniazid, rifampin and pyrazinamide. Which of the following instructions should the nurse include? •1) "Take isoniazid with an antacid." •2) "Provide a sputum specimen every 2 weeks to the clinic for testing." •3) "Expect your sputum cultures to be negative after 6 months of therapy." •4) "Drink at least 8 ounces of water when you take the pyrazinamide tablet."

ANS: 4. •A client who has tuberculosis usually takes pyrazinamide for the first 2 months of therapy and can shorten the entire course of therapy to 6 months. The nurse should instruct the client to drink at least 240 mL (8 oz) of fluid when taking the medication and to protect himself from the sun with cotton clothing and sunscreen.

A nurse is providing discharge teaching to a client who has pulmonary tuberculosis and a new prescription for rifampin. Which of the following information should the nurse provide? •1) "Treatment with this medication will last for 1 month." •2) "This medication can cause insomnia." •3) "It is best to take the medication with meals." •4) "Urine and other secretions might turn orange."

ANS: 4. •Answer Rationale: •Rifampin might turn the urine and other secretions reddish-orange. This includes sputum, tears, and sweat.

A nurse is assessing a client who is 1 day postoperative following a lobectomy and has a chest tube drainage system in place. Which of the following findings by the nurse indicates a need for intervention? •1) Chest tube eyelets not visible. •2) Continuous bubbling in the suction control chamber •3) Presence of tidal fluctuation in the water seal chamber •4) Development of subcutaneous emphysema

ANS: 4. •Subcutaneous emphysema is an indication that air is trapped in and under the skin, which be the result of a pneumothorax and should be reported to the provider.

A nurse is monitoring a client who has a chest tube in place connected to wall suction due to a right-sided pneumothorax. The client complains of chest burning. Which of the following actions should the nurse take? •1) Increase the client's wall suction. •2) Strip the client's chest tube. •3) Clamp the client's chest tube. •4) Reposition the client.

ANS: 4. •The nurse increasing the wall suction does not affect the amount of negative pressure of the chest tube and would not relieve the client's chest burning. •The nurse stripping the chest tube increases negative pressure and may damage lung tissue and would not resolve the client's chest burning.