Respiratory

The nurse is caring for a patient who is scheduled for a lobectomy for a diagnosis of lung cancer. While assisting with a subclavian vein central line insertion, the nurse notes the clients oxygen saturation rapidly dropping. The patient complains of shortness of breath and becomes tachypneic. The nurse suspects a pneumothorax has developed. Further assessment findings supporting the presence of a pneumothorax include what? A) Diminished or absent breath sounds on the affected side B) Paradoxical chest wall movement with respirations C) Sudden loss of consciousness D) Muffled heart sounds

A) Diminished or absent breath sounds on the affected side

A critical care nurse is caring for a client with an endotracheal tube who is on a ventilator. The nurse knows that meticulous airway management of this patient is necessary. What is the main rationale for this? A) Maintaining a patent airway B) Preventing the need for suctioning C) Maintaining the sterility of the patients airway D) Increasing the patients lung compliance

A) Maintaining a patent airway

The nurse is assessing an adult patient following a motor vehicle accident. The nurse observes that the patient has an increased use of accessory muscles and is complaining of chest pain and shortness of breath. The nurse should recognize the possibility of what condition? A) Pneumothorax B) Anxiety C) Acute bronchitis D) Aspiration

A) Pneumothorax

A patient has been brought to the ED by the paramedics. The patient is suspected of having ARDS. What intervention should the nurse first anticipate? A) Preparing to assist with intubating the patient B) Setting up oxygen at 5 L/minute by nasal cannula C) Performing deep suctioning D) Setting up a nebulizer to administer corticosteroids

A) Preparing to assist with intubating the patient

Which instruction does the nurse document in the diet plan for the patient with chronic obstructive pulmonary disease (COPD)? A. "Eat egg custard every day." B. "Include cabbage in your diet." C. "Include cauliflower in your diet." D. "Eat hot tomato soup as much as possible."

A. "Eat egg custard every day."

A patient is diagnosed with pulmonary embolism. What nursing actions are appropriate for this patient? Select all that apply. A. Administer oxygen therapy as prescribed. B. Keep the patient on bed rest in a supine position. C.Maintain an IV line for medications and fluid therapy. D. Instruct the patient not to cough or perform deep breathing. E. Monitor the patient for complications of anticoagulant therapy.

A. Administer oxygen therapy as prescribed. C.Maintain an IV line for medications and fluid therapy. E. Monitor the patient for complications of anticoagulant therapy.

A patient with chronic obstructive pulmonary disease (COPD) is experiencing anxiety. What medication as ordered should the nurse administer to this patient? A. Buspirone B. Tiotropium C. Indacaterol D. Roflumilast

A. Buspirone

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who has increased B-type natriuretic peptide (BNP) levels. What treatment option does the nurse anticipate administering to this patient? A. Diuretics B. Albuterol C. Roflumilast D. Long-acting beta agonists

A. Diuretics

The nurse is caring for a patient who is receiving continuous oxygen (O 2) therapy. The nurse knows that the method of O 2 administration for the patient depends upon which factors? Select all that apply. A. Financial resources B. Patient's cooperation C. Comfort of the device D. Patient's cultural status E. Humidification required F. Fraction of inspired oxygen (FiO 2) required

A. Financial resources B. Patient's cooperation C. Comfort of the device E. Humidification required F. Fraction of inspired oxygen (FiO 2) required

A nurse is using an airway clearance device to mobilize secretions in a patient with chronic obstructive pulmonary disease (COPD). The nurse instructs the patient, "You must sit in an upright position during the process." Which device does the nurse use during this procedure? A. Flutter B. Acapella C. SmartVest D. TheraPEP therapy system

A. Flutter

A patient who has been diagnosed with tuberculosis states, "I am not taking my medication, because I cannot afford it." Which ethical practices does the nurse demonstrate by implementing a social service consult to assist the patient in obtaining the medication needed for treatment? Select all that apply. A. Patient advocacy B. Community advocacy C. Adherence to treatment D. Provision of direct observed therapy E. Providing a legal process for medication compliance

A. Patient advocacy B. Community advocacy

Pulmonary rehabilitation (PR) is an evidence-based intervention that includes many disciplines working together to individualize treatment of the symptomatic chronic obstructive pulmonary disease (COPD) patient. What is PR designed to do? Select all that apply. A. Reduce symptoms B. Improve quality of life C. Reduce effort by teaching to inhale when pushing D. Enhance rest by teaching to exhale with relaxation E. Provide a "last ditch" effort for patients with COPD

A. Reduce symptoms B. Improve quality of life

The nurse is caring for a patient with severe chronic obstructive pulmonary disease (COPD) who has frequent exacerbations. What treatment strategy does the nurse recognize would be most beneficial for this patient? A. Roflumilast B. Indacaterol C. Ipratropium D. Salmeterol and formoterol

A. Roflumilast

The nurse is caring for a patient who is suspected of having chronic obstructive pulmonary disease (COPD). The nurse knows that what type of diagnostic test would confirm this diagnosis? A. Spirometry B. Chest x-ray C. Arterial blood gas (ABG) D. Computed tomography (CT) scan of the chest

A. Spirometry

The nurse is performing chest physiotherapy on a patient with chronic obstructive pulmonary disease. What appropriate techniques should be used when performing the procedure on this patient? Select all that apply. A. Vibration B. Percussion C. Huff coughing D. Postural drainage E. Pursed-lip breathing

A. Vibration B. Percussion D. Postural drainage

A patient with thoracic trauma is admitted to the ICU. The nurse notes the patients chest and neck are swollen and there is a crackling sensation when palpated. The nurse consequently identifies the presence of subcutaneous emphysema. If this condition becomes severe and threatens airway patency, what intervention is indicated? A) A chest tube B) A tracheostomy C) An endotracheal tube D) A feeding tube

B) A tracheostomy

An admitting nurse is assessing a patient with COPD. The nurse auscultates diminished breath sounds, which signify changes in the airway. These changes indicate to the nurse to monitor the patient for what? A) Kyphosis and clubbing of the fingers B) Dyspnea and hypoxemia C) Sepsis and pneumothorax D) Bradypnea and pursed lip breathing

B) Dyspnea and hypoxemia

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). The patient has been receiving high-flow oxygen therapy for an extended time. What symptoms should the nurse anticipate if the patient were experiencing oxygen toxicity? A) Bradycardia and frontal headache B) Dyspnea and substernal pain C) Peripheral cyanosis and restlessness D) Hypotension and tachycardia

B) Dyspnea and substernal pain

An asthma educator is teaching a patient newly diagnosed with asthma and her family about the use of a peak flow meter. The educator should teach the patient that a peak flow meter measures what value? A) Highest airflow during a forced inspiration B) Highest airflow during a forced expiration C) Airflow during a normal inspiration D) Airflow during a normal expiration Ans:

B) Highest airflow during a forced expiration

A patient is receiving thrombolytic therapy for the treatment of pulmonary emboli. What is the best way for the nurse to assess the patients oxygenation status at the bedside? A) Obtain serial ABG samples. B) Monitor pulse oximetry readings. C) Test pulmonary function. D) Monitor incentive spirometry volumes.

B) Monitor pulse oximetry readings.

postoperative period, with oxygen saturation readings between 89% and 91%. What method of oxygen delivery is most appropriate for the patients needs? A) Non-rebreathing mask B) Nasal cannula C) Simple mask D) Partial-rebreathing mask

B) Nasal cannula

Which statement made by the patient indicates the need for further teaching about safety measures for oxygen therapy in a home care setting? Select all that apply. Select all that apply A. "I should avoid smoking in the house." B. "I may use wool blankets in the house." C. "I may use aerosol sprays in the house." D. "I should avoid paint thinners in the house." E. "I should wipe the oxygen concentrator with a damp cloth." F. "I should wash the nasal cannula (prongs) with a liquid soap."

B. "I may use wool blankets in the house." C. "I may use aerosol sprays in the house."

Which statements made by the patient with chronic cough, sputum production, and dyspnea indicate effective learning about his or her dietary instructions? Select all that apply. Select all that apply A. "I should avoid skim milk." B. "I should avoid beans and cabbage." C. "I should eat cold foods and desserts during meal time." D. "I should drink more than eight ounces of water at every meal." E. "I should eat peanut butter and mayonnaise-containing foods."

B. "I should avoid beans and cabbage." C. "I should eat cold foods and desserts during meal time." E. "I should eat peanut butter and mayonnaise-containing foods."

The nurse is assessing a patient who may have manifestations of chronic obstructive pulmonary disease (COPD). Which of these is a clinical manifestation of early COPD? A. Dyspnea at rest B. A chronic, intermittent cough C. The presence of chest breathing D. Production of copious amounts of sputum

B. A chronic, intermittent cough

On examining a patient with asthma the nurse finds that the patient experiences asthmatic symptoms throughout the day, besides experiencing night-time awakenings more than four times a week. The patient's forced expiratory volume in the first second of expiration (FEV 1) is less than 60%, and normal activity is very limited. Which treatment option should the nurse consider appropriate? A. Follow up after a month. B. Consider oral corticosteroids. C. Reevaluate in two to six weeks. D. Advise maintaining control of asthma symptoms.

B. Consider oral corticosteroids.

When planning teaching for the patient with chronic obstructive pulmonary disease (COPD), the nurse understands that what causes the manifestations of the disease? A. An overproduction of the antiprotease a 1-antitrypsin B. Hyperinflation of alveoli and destruction of alveolar walls C. Hypertrophy and hyperplasia of goblet cells in the bronchi D. Collapse and hypoventilation of the terminal respiratory unit

B. Hyperinflation of alveoli and destruction of alveolar walls

A nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) postoperatively. After assessing the patient, the nurse finds that the patient has respiratory failure. Which classes of medications should the nurse question if ordered by the primary health care provider? Select all that apply. A. Some correct answers were not selected B. Opioids C. Diuretics D. Sedatives E. Benzodiazepines F. β 2-adrenergic blockers

B. Opioids D. Sedatives E. Benzodiazepines

The nurse is caring for a patient diagnosed with cor pulmonale. What symptoms assessed by the nurse correlate with the assigned diagnosis? A.Oxygen saturation of 92% B. Presence of edema in the ankles C. Yellowish discoloration of the skin D. Partial pressure of arterial oxygen (PaO 2) is 60 mm Hg

B. Presence of edema in the ankles

The patient has been receiving oxygen by nasal cannula. The nurse suspects the patient is experiencing oxygen toxicity after noting which finding? A. Tachypnea B. Restlessness C. Diminished lung sounds D. Oxygen saturation 98%

B. Restlessness

While reviewing the laboratory reports of a patient with a chronic cough, dyspnea, and lung inflammation, the nurse finds that the patient has a forced expiratory volume of 55%. Which treatment strategy would be most effective for this patient? A. Roflumilast B. Salmeterol and formoterol C. Lung volume reduction surgery D. 50% oxygen at 8 L/minute concentration

B. Salmeterol and formoterol

A patient presents to the ED stating she was in a boating accident about 3 hours ago. Now the patient has complaints of headache, fatigue, and the feeling that he just cant breathe enough. The nurse notes that the patient is restless and tachycardic with an elevated blood pressure. This patient may be in the early stages of what respiratory problem? A) Pneumoconiosis B) Pleural effusion C) Acute respiratory failure D) Pneumonia

C) Acute respiratory failure

The nurse is providing discharge teaching for a patient who developed a pulmonary embolism after total knee surgery. The patient has been converted from heparin to sodium warfarin (Coumadin) anticoagulant therapy. What should the nurse teach the client? A) Coumadin will continue to break up the clot over a period of weeks B) Coumadin must be taken concurrent with ASA to achieve anticoagulation. C) Anticoagulant therapy usually lasts between 3 and 6 months. D) He should take a vitamin supplement containing vitamin K

C) Anticoagulant therapy usually lasts between 3 and 6 months.

he nurse is preparing to suction a patient with an endotracheal tube. What should be the nurses first step in the suctioning process? A) Explain the suctioning procedure to the patient and reposition the patient. B) Turn on suction source at a pressure not exceeding 120 mm Hg. C) Assess the patients lung sounds and SAO2 via pulse oximeter. D) Perform hand hygiene and don nonsterile gloves, goggles, gown, and mask.

C) Assess the patients lung sounds and SAO2 via pulse oximeter.

A nurse has performed tracheal suctioning on a patient who experienced increasing dyspnea prior to a procedure. When applying the nursing process, how can the nurse best evaluate the outcomes of this intervention? A) Determine whether the patient can now perform forced expiratory technique (FET). B) Percuss the patients lungs and thorax. C) Measure the patients oxygen saturation. D) Have the patient perform incentive spirometry.

C) Measure the patients oxygen saturation.

While assessing the patient, the nurse observes constant bubbling in the water-seal chamber of the patients closed chest-drainage system. What should the nurse conclude? A) The system is functioning normally. B) The patient has a pneumothorax. C) The system has an air leak. D) The chest tube is obstructed.

C) The system has an air leak.

A patient with a severe exacerbation of COPD requires reliable and precise oxygen delivery. Which mask will the nurse expect the physician to order? A) Non-rebreather air mask B) Tracheostomy collar C) Venturi mask D) Face tent

C) Venturi mask

Nursing assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)? A. Acute respiratory failure B. Secondary respiratory infection C. Fluid volume excess resulting from cor pulmonale D. Pulmonary edema caused by left-sided heart failure

C. Fluid volume excess resulting from cor pulmonale

A patient who was in a motor vehicle accident is brought to the emergency department unconscious, and cardiopulmonary resuscitation (CPR) is performed. The patient responds well, and the condition improves. After several hours, the patient experiences dyspnea and becomes cyanotic. On examination, the neck veins are distended and the patient is tachycardic. The nurse expects that the immediate plan for treatment will include what intervention? A. Pericardiocentesis B. Oxygen administration C. Needle decompression D. Placing the patient in a side-lying position

C. Needle decompression

Which finding helped the nurse reach the conclusion that a patient with chronic obstructive pulmonary disease (COPD) requires oxygen therapy? A. Hemoglobin levels of 13.6 g/dL B. Red blood cell count 5 million cells/microliter C. Partial pressure of oxygen (PaO 2) 52 mm Hg D. Saturation of hemoglobin (SaO 2) 90% at rest

C. Partial pressure of oxygen (PaO 2) 52 mm Hg

The nurse checks for which abnormal physical assessment findings consistent with cor pulmonale? Select all that apply. A. Crackles B. Wheezing C. Pedal edema D. Hepatomegaly E. Jugular vein distention

C. Pedal edema D. Hepatomegaly E. Jugular vein distention

The nurse cares for a patient with emphysema. What change in the alveolar sacs is the pathophysiological change in the lungs most characteristic of this disease? A. The alveolar sacs collapse. B. The alveolar sacs retain CO 2. C. The alveolar sacs are overdistended. D. The alveolar sacs become filled with fluid.

C. The alveolar sacs are overdistended.

The medical nurse is creating the care plan of an adult patient requiring mechanical ventilation. What nursing action is most appropriate? A) Keep the patient in a low Fowlers position. B) Perform tracheostomy care at least once per day. C) Maintain continuous bedrest. D) Monitor cuff pressure every 8 hours.

D) Monitor cuff pressure every 8 hours.

A patient is having pulmonary-function studies performed. The patient performs a spirometry test, revealing an FEV1/FVC ratio of 60%. How should the nurse interpret this assessment finding? A) Strong exercise tolerance B) Exhalation volume is normal C) Respiratory infection D) Obstructive lung disease

D) Obstructive lung disease

A patient in the outpatient clinic has symptoms including chronic cough, sputum production, and dyspnea. On taking a detailed history of the patient, the nurse finds that this patient has a prolonged exposure to smoke. Which condition would the nurse most likely suspect the patient to have? A. Influenza B. Pneumonia C. Tuberculosis D. Chronic obstructive pulmonary disease (COP

D. Chronic obstructive pulmonary disease (COPD)

A patient with late-stage chronic obstructive pulmonary disease (COPD) presented to the emergency room with increasing dyspnea. Lab results indicate a pH of 7.36, a PaCO 2 of 47 mm Hg, and a HCO 3 of 25 mEq/L. The patient asks the nurse what these lab results mean. What does the nurse know this lab data indicates? A. Severe hypoxemia B. Early respiratory failure C. All results are within normal limits D. Compensated respiratory acidosis

D. Compensated respiratory acidosis

Which laboratory finding helped the nurse reach the conclusion that a patient with a chronic cough and dyspnea has hypercapnia? A. Hemoglobin concentration is 14 g/dL. B. Red blood cell count is 4.9 million cells/microliter. C. Partial pressure of arterial oxygen (PaO 2) is 75 mm Hg. D. Partial pressure of carbon dioxide (PaCO 2) is 55 mm Hg.

D. Partial pressure of carbon dioxide (PaCO 2) is 55 mm Hg.

While caring for a patient with a chronic cough and dyspnea associated with the inflammation of lung parenchyma, a nurse instructs the patient, "You should reduce the salt in your diet." What is the reason behind this instruction? A. The patient has cor pulmonale. B. The patient underwent a bullectomy. C. The patient is on corticosteroid therapy. D. The patient is on bronchodilator therapy.

The patient has cor pulmonale.

The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with obstructive pulmonary disease. Which patient will require the most rapid action by the nurse? a. 22-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg b. 34-year-old with ABG results: pH 7.48, PaCO2 30 mm Hg, and PaO2 65 mm Hg c. 45-year-old with ABG results: pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg d. 65-year-old with ABG results: pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg

a. 22-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg

A patient who is experiencing an asthma attack develops bradycardia and a decrease in wheezing. Which action should the nurse take first? a. Notify the health care provider. b. Document changes in respiratory status. c. Encourage the patient to cough and deep breathe. d. Administer IV methylprednisolone (Solu-Medrol).

a. Notify the health care provider.

The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment would best evaluate the effectiveness of the therapies? a. Observe for distended neck veins. b. Auscultate for crackles in the lungs. c. Palpate for heaves or thrills over the heart. d. Review hemoglobin and hematocrit values.

a. Observe for distended neck veins.

The nurse cares for a patient who has just had a thoracentesis. Which assessment information obtained by the nurse is a priority to communicate to the health care provider? a. Oxygen saturation is 88%. b. Blood pressure is 145/90 mm Hg. c. Respiratory rate is 22 breaths/minute when lying flat. d. Pain level is 5 (on 0 to 10 scale) with a deep breath.

a. Oxygen saturation is 88%.

A patient experiences a chest wall contusion as a result of being struck in the chest with a baseball bat. The emergency department nurse would be most concerned if which finding is observed during the initial assessment? a. Paradoxic chest movement b. Complaint of chest wall pain c. Heart rate of 110 beats/minute d. Large bruised area on the chest

a. Paradoxic chest movement

The nurse assesses a patient with chronic obstructive pulmonary disease (COPD) who has been admitted with increasing dyspnea over the last 3 days. Which finding is most important for the nurse to report to the health care provider? a. Respirations are 36 breaths/minute. b. Anterior-posterior chest ratio is 1:1. c. Lung expansion is decreased bilaterally. d. Hyperresonance to percussion is present.

a. Respirations are 36 breaths/minute.

The nurse is caring for a mechanically ventilated patient with a cuffed tracheostomy tube. Which action by the nurse would best determine if the cuff has been properly inflated? a. Use a manometer to ensure cuff pressure is at an appropriate level. b. Check the amount of cuff pressure ordered by the health care provider. c. Suction the patient first with a fenestrated inner cannula to clear secretions. d. Insert the decannulation plug before the nonfenestrated inner cannula is removed.

a. Use a manometer to ensure cuff pressure is at an appropriate level.

The nurse monitors a patient after chest tube placement for a hemopneumothorax. The nurse is most concerned if which assessment finding is observed? a. A large air leak in the water-seal chamber b. 400 mL of blood in the collection chamber c. Complaint of pain with each deep inspiration d. Subcutaneous emphysema at the insertion site

b. 400 mL of blood in the collection chamber

The nurse receives change-of-shift report on the following four patients. Which patient should the nurse assess first? a. A 23-year-old patient with cystic fibrosis who has pulmonary function testing scheduled b. A 46-year-old patient on bed rest who is complaining of sudden onset of shortness of breath c. A 77-year-old patient with tuberculosis (TB) who has four antitubercular medications due in 15 minutes 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)

b. A 46-year-old patient on bed rest who is complaining of sudden onset of shortness of breath

The nurse receives a change-of-shift report on the following patients with chronic obstructive pulmonary disease (COPD). Which patient should the nurse assess first? a. A patient with loud expiratory wheezes b. A patient with a respiratory rate of 38/minute c. A patient who has a cough productive of thick, green mucus d. A patient with jugular venous distention and peripheral edema

b. A patient with a respiratory rate of 38/minute

18. After the nurse has received change-of-shift report, which patient should the nurse assess first? a. A patient with pneumonia who has crackles in the right lung base b. A patient with possible lung cancer who has just returned after bronchoscopy c. A patient with hemoptysis and a 16-mm induration with tuberculin skin testing d. A patient with chronic obstructive pulmonary disease (COPD) and pulmonary function testing (PFT) that indicates low forced vital capacity

b. A patient with possible lung cancer who has just returned after bronchoscopy

When caring for a patient who is hospitalized with active tuberculosis (TB), the nurse observes a student nurse who is assigned to take care of a patient. Which action, if performed by the student nurse, would require an intervention by the nurse? a. The patient is offered a tissue from the box at the bedside. b. A surgical face mask is applied before visiting the patient. c. A snack is brought to the patient from the unit refrigerator. d. Hand washing is performed before entering the patients room.

b. A surgical face mask is applied before visiting the patient.

After 2 months of tuberculosis (TB) treatment with isoniazid (INH), rifampin (Rifadin), pyrazinamide (PZA), and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next? a. Teach about treatment for drug-resistant TB treatment. b. Ask the patient whether medications have been taken as directed. c. Schedule the patient for directly observed therapy three times weekly. d. Discuss with the health care provider the need for the patient to use an injectable antibiotic.

b. Ask the patient whether medications have been taken as directed.

Following a laryngectomy a patient coughs violently during suctioning and dislodges the tracheostomy tube. Which action should the nurse take first? a. Cover stoma with sterile gauze and ventilate through stoma. b. Attempt to reinsert the tracheostomy tube with the obturator in place. c. Assess the patients oxygen saturation and notify the health care provider. d. Ventilate the patient with a manual bag and face mask until the health care provider arrives.

b. Attempt to reinsert the tracheostomy tube with the obturator in place.

The clinic nurse makes a follow-up telephone call to a patient with asthma. The patient reports having a baseline peak flow reading of 600 L/minute and the current peak flow is 420 L/minute. Which action should the nurse takefirst? a. Tell the patient to go to the hospital emergency department. b. Instruct the patient to use the prescribed albuterol (Proventil). c. Ask about recent exposure to any new allergens or asthma triggers. d. Question the patient about use of the prescribed inhaled corticosteroids.

b. Instruct the patient to use the prescribed albuterol (Proventil).

The nurse teaches a patient about the transmission of pulmonary tuberculosis (TB). Which statement, if made by the patient, indicates that teaching was effective? a. I will avoid being outdoors whenever possible. b. My husband will be sleeping in the guest bedroom. c. I will take the bus instead of driving to visit my friends. d. I will keep the windows closed at home to contain the germs.

b. My husband will be sleeping in the guest bedroom.

A patient is admitted to the emergency department with an open stab wound to the left chest. What is the first action that the nurse should take? a. Position the patient so that the left chest is dependent. b. Tape a nonporous dressing on three sides over the chest wound. c. Cover the sucking chest wound firmly with an occlusive dressing. d. Keep the head of the patients bed at no more than 30 degrees elevation.

b. Tape a nonporous dressing on three sides over the chest wound.

A patient with chronic obstructive pulmonary disease (COPD) has rhonchi throughout the lung fields and a chronic, nonproductive cough. Which nursing intervention will be most effective? a. Change the oxygen flow rate to the highest prescribed rate. b. Teach the patient to use the Flutter airway clearance device. c. Reinforce the ongoing use of pursed lip breathing techniques. d. Teach the patient about consistent use of inhaled corticosteroids.

b. Teach the patient to use the Flutter airway clearance device.

A patient seen in the asthma clinic has recorded daily peak flows that are 75% of the baseline. Which action will the nurse plan to take next? a. Increase the dose of the leukotriene inhibitor. b. Teach the patient about the use of oral corticosteroids. c. Administer a bronchodilator and recheck the peak flow. d. Instruct the patient to keep the next scheduled follow-up appointment.

c. Administer a bronchodilator and recheck the peak flow.

A patient with a tracheostomy has a new order for a fenestrated tracheostomy tube. Which action should the nurse include in the plan of care in collaboration with the speech therapist? a. Leave the tracheostomy inner cannula inserted at all times. b. Place the decannulation cap in the tube before cuff deflation. c. Assess the ability to swallow before using the fenestrated tube. d. Inflate the tracheostomy cuff during use of the fenestrated tube.

c. Assess the ability to swallow before using the fenestrated tube

A patient with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would be most appropriate? a. Have the patient rest in bed with the head elevated to 15 to 20 degrees. b. Ask the patient to rest in bed in a high-Fowlers position with the knees flexed. c. Encourage the patient to sit up at the bedside in a chair and lean slightly forward. d. Place the patient in the Trendelenburg position with several pillows behind the head.

c. Encourage the patient to sit up at the bedside in a chair and lean slightly forward.

A patient who is taking rifampin (Rifadin) for tuberculosis calls the clinic and reports having orange discolored urine and tears. Which is the best response by the nurse? a. Ask if the patient is experiencing shortness of breath, hives, or itching. b. Ask the patient about any visual abnormalities such as red-green color discrimination. c. Explain that orange discolored urine and tears are normal while taking this medication. d. Advise the patient to stop the drug and report the symptoms to the health care provider.

c. Explain that orange discolored urine and tears are normal while taking this medication.

The nurse provides preoperative instruction for a patient scheduled for a left pneumonectomy for cancer of the lung. Which information should the nurse include about the patients postoperative care? a. Positioning on the right side b. Bed rest for the first 24 hours c. Frequent use of an incentive spirometer d. Chest tube placement with continuous drainage

c. Frequent use of an incentive spirometer

he nurse notes that a patient has incisional pain, a poor cough effort, and scattered rhonchi after a thoracotomy. Which action should the nurse take first? a. Assist the patient to sit upright in a chair. b. Splint the patients chest during coughing. c. Medicate the patient with prescribed morphine. d. Observe the patient use the incentive spirometer.

c. Medicate the patient with prescribed morphine.

A nurse who is caring for patient with a tracheostomy tube in place has just auscultated rhonchi bilaterally. If the patient is unsuccessful in coughing up secretions, what action should the nurse take? a. Encourage increased incentive spirometer use. b. Encourage the patient to increase oral fluid intake. c. Put on sterile gloves and use a sterile catheter to suction. d. Preoxygenate the patient for 3 minutes before suctioning.

c. Put on sterile gloves and use a sterile catheter to suction.

A patient who has a right-sided chest tube following a thoracotomy has continuous bubbling in the suction-control chamber of the collection device. Which action by the nurse is most appropriate? a. Document the presence of a large air leak. b. Notify the surgeon of a possible pneumothorax. c. Take no further action with the collection device. d. Adjust the dial on the wall regulator to decrease suction.

c. Take no further action with the collection device.

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). Which information obtained from the patient would prompt the nurse to consult with the health care provider before administering the prescribed theophylline? a. The patient reports a recent 15-pound weight gain. b. The patient denies any shortness of breath at present. c. The patient takes cimetidine (Tagamet) 150 mg daily. d. The patient complains about coughing up green mucus.

c. The patient takes cimetidine (Tagamet) 150 mg daily.

Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB. Which information should the occupational health nurse plan to teach the staff nurse? a. Standard four-drug therapy for TB b. Need for annual repeat TB skin testing c. Use and side effects of isoniazid (INH) d. Bacille Calmette-Gurin (BCG) vaccine

c. Use and side effects of isoniazid (INH)

After change-of-shift report, which patient should the nurse assess first? a. 72-year-old with cor pulmonale who has 4+ bilateral edema in his legs and feet b. 28-year-old with a history of a lung transplant and a temperature of 101 F (38.3 C) c. 40-year-old with a pleural effusion who is complaining of severe stabbing chest pain d. 64-year-old with lung cancer and tracheal deviation after subclavian catheter insertion

d. 64-year-old with lung cancer and tracheal deviation after subclavian catheter insertion

A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. The nurse finds a heart rate of 142 beats/minute, blood pressure of 100/60 mmHg, and respirations of 42 breaths/minute. Which action should the nurse take first? a. Administer anticoagulant drug therapy. b. Notify the patients health care provider. c. Prepare patient for a spiral computed tomography (CT). d. Elevate the head of the bed to a semi-Fowlers position.

d. Elevate the head of the bed to a semi-Fowlers position.

Postural drainage with percussion and vibration is ordered twice daily for a patient with chronic bronchitis. Which intervention should the nurse include in the plan of care? a. Schedule the procedure 1 hour after the patient eats. b. Maintain the patient in the lateral position for 20 minutes. c. Perform percussion before assisting the patient to the drainage position. d. Give the ordered albuterol (Proventil) before the patient receives the therapy.

d. Give the ordered albuterol (Proventil) before the patient receives the therapy.

The nurse is performing tuberculosis (TB) skin tests in a clinic that has many patients who have immigrated to the United States. Which question is most important for the nurse to ask before the skin test? a. Is there any family history of TB? b. How long have you lived in the United States? c. Do you take any over-the-counter (OTC) medications? d. Have you received the bacille Calmette-Gurin (BCG) vaccine for TB?

d. Have you received the bacille Calmette-Gurin (BCG) vaccine for TB?

patient with pneumonia has a fever of 101.4 F (38.6 C), a nonproductive cough, and an oxygen saturation of 88%. The patient complains of weakness, fatigue, and needs assistance to get out of bed. Which nursing diagnosis should the nurse assign as the highest priority? a. Hyperthermia related to infectious illness b. Impaired transfer ability related to weakness c. Ineffective airway clearance related to thick secretions d. Impaired gas exchange related to respiratory congestion

d. Impaired gas exchange related to respiratory congestion

When assessing a patient who has just arrived after an automobile accident, the emergency department nurse notes tachycardia and absent breath sounds over the right lung. For which intervention will the nurse prepare the patient? a. Emergency pericardiocentesis b. Stabilization of the chest wall with tape c. Administration of an inhaled bronchodilator d. Insertion of a chest tube with a chest drainage system

d. Insertion of a chest tube with a chest drainage system

An hour after a thoracotomy, a patient complains of incisional pain at a level 7 (based on 0 to 10 scale) and has decreased left-sided breath sounds. The pleural drainage system has 100 mL of bloody drainage and a large air leak. Which action is best for the nurse to take next? a. Milk the chest tube gently to remove any clots. b. Clamp the chest tube momentarily to check for the origin of the air leak. c. Assist the patient to deep breathe, cough, and use the incentive spirometer. d. Set up the patient controlled analgesia (PCA) and administer the loading dose of morphine.

d. Set up the patient controlled analgesia (PCA) and administer the loading dose of morphine.

A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of impaired breathing pattern related to anxiety. Which nursing action is most appropriate to include in the plan of care? a. Titrate oxygen to keep saturation at least 90%. b. Discuss a high-protein, high-calorie diet with the patient. c. Suggest the use of over-the-counter sedative medications. d. Teach the patient how to effectively use pursed lip breathing.

d. Teach the patient how to effectively use pursed lip breathing.

The nurse teaches a patient who has asthma about peak flow meter use. Which action by the patient indicates that teaching was successful? a. The patient inhales rapidly through the peak flow meter mouthpiece. b. The patient takes montelukast (Singulair) for peak flows in the red zone. c. The patient calls the health care provider when the peak flow is in the green zone. d. The patient uses albuterol (Proventil) metered dose inhaler (MDI) for peak flows in the yellow zone. ANS: D

d. The patient uses albuterol (Proventil) metered dose inhaler (MDI) for peak flows in the yellow zone.

patient is admitted with active tuberculosis (TB). The nurse should question a health care providers order to discontinue airborne precautions unless which assessment finding is documented? a. Chest x-ray shows no upper lobe infiltrates. b. TB medications have been taken for 6 months. c. Mantoux testing shows an induration of 10 mm. d. Three sputum smears for acid-fast bacilli are negative.

d. Three sputum smears for acid-fast bacilli are negative.

The laboratory has just called with the arterial blood gas (ABG) results on four patients. Which result is most important for the nurse to report immediately to the health care provider? a. pH 7.34, PaO2 82 mm Hg, PaCO2 40 mm Hg, and O2 sat 97% b. pH 7.35, PaO2 85 mm Hg, PaCO2 45 mm Hg, and O2 sat 95% c. pH 7.46, PaO2 90 mm Hg, PaCO2 32 mm Hg, and O2 sat 98% d. pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96%

d. pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96% These ABGs indicate uncompensated respiratory acidosis and should be reported to the health care provider. The other values are normal or close to normal.