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Voorbeeld 3 van de 19 pagina's
Tentamen (uitwerkingen)

ATI Respiratory Med-Surg Latest version 2024 (Question and answers)

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Voorbeeld 3 van de 19 pagina's

ATI Respiratory Med-Surg Latest version 2024 (Question and answers)

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ATI Respiratory Med -Surg Latest version 2024 (Question and answers) A charge nurse receives notification of the admission of a client who is coughing frequently and whose sputum is pink, frothy, and copious. The client has a history of night sweats, anorexia, and weight loss. Which of the following actions should the nurse take? (Select all that apply.) A. Assign the client to a private room with negative -pressure airflow B. Add contact precautions to the client's plan of care C. Wear an N95 respirator when enter ing the client's room D. Ensure the client's environment provides 4 exchanges of fresh air per minute E. Institute protective environment precautions as soon as the client arrives on the unit - ANS-a,c A nurse is reinforcing teaching about breathing techniques with a client who has emphysema. Which of the following statements should the nurse identify as an indication that the client understands the mechanics behind pursed -lip breathing? A. "I'll inhale slowly through pursed lips to help me breathe better." B. "When I do my pursed -lip breathing, I'll lie down first." C. "When I breathe out through pursed lips, my airways don't collapse between breaths." D. "I'll relax my stomach muscles when I am doin g my pursed -lip breathing exercises." - ANS-d A nurse is assisting with the plan of care for a client who has chronic obstructive pulmonary disease (COPD) and is malnourished. Which of the fol lowing recommendations to promote nutritional intake should the nurse include in the plan? A. Eat high -calorie foods first B. Increase intake of water at mealtimes C. Perform active range -of-motion exercises before meals D. Keep saltine crackers nearby for snacking - ANS-a a nurse is reinforcing preoperative teaching with a client who has lung cancer and will undergo a pneumonectomy. Which of the following pieces of informatio n should the nurse include? (Select all that apply.) A. "You will have a chest tube in place after surgery." B. "We'll help you turn, cough, and breathe deeply frequently after surgery." C. "You will have to remain in bed for about 2 days after the surg ery." D. "We'll give you oxygen to support your breathing if you need it." E. "You should expect pain for the first few days after surgery." - ANS-a,b,d A nurse is caring for a client who has a 20 -year history of COPD and is receiving oxygen at 2 L/min v ia nasal cannula. The client is dyspneic and has an oxygen saturation via pulse oximetry of 85%. Which of the following actions should the nurse take? A. Place a nonrebreather mask on the client and increase the oxygen flow to 3 L/min B. Prepare the clien t for the possibility of endotracheal intubation and mechanical ventilation C. Increase the oxygen flow and request an arterial blood gas determination D. Position the client supine and administer an antianxiety medication - ANS-c A nurse is preparing a client for discharge following a bronchoscopy. Which of the following assessments is the nurse's monitoring priority? A. Measuring heart rate B. Palpating peripheral pulses C. Observing sputum for blood D. Confirming the gag reflex - ANS-d A nurse is caring for a client who is postoperative following a thoracic lobectomy. The client has 2 chest tubes in place, 1 in the lower portion of the thorax and the other higher up on the chest wall. When the family asks the nurse why the client has 2 c hest tubes, which of the following responses should the nurse make? A. "Two tubes were necessary due to excessive bleeding from the area of the surgery." B. "The tubes drain blood from 2 different lung areas." C. "The lower tube will drain blood, and th e higher tube will remove air." D. "The second tube will take over if blood clots block the first." - ANS-c A nurse is collecting data from a client who has a positive tuberculin skin test. Which of the following findings should the nurse identify as an indication that the client has active tuberculosis? A. Rhinitis B. Air hunger C. Nig ht sweats

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