Med Surg A Exam 2

The nurse recognizes that which process occurs as oxygen and carbon dioxide are exchanged at the level of the alveoli. 1. Diffusion 2. Perfusion 3. Respiration 4. Ventilation 3. Respiration Which structure of the respiratory system is responsible for filtering, warming, and humidifying inhaled air? 1. Alveoli 2. Pharynx 3. Sinuses 4. Turbinates 4. Turbinates In providing health education to a group of middle school students, how does the nurse describe the function of the epiglottis? 1. Aids in the sensation of smell 2. Conducts gases to the alveoli 3. Filters small particles before air enters the lungs 4. Prevents the entry of solids and liquids into the lungs 4. Prevents the entry of solids and liquids into the lungs The nurse is conducting a respiratory assessment for a patient who is diagnosed with asthma. Which assessment finding does the nurse monitor for with this diagnosis? 1. Hemoptysis 2. Dry cough 3. Productive cough 4. Coarse crackles 2. Dry cough The nurse is assessing a patient who is diagnosed with tuberculosis. Which assessment finding supports this diagnosis? 1. Wheezing 2. Hemoptysis 3. Pleural friction rub 4. Slightly whitish sputum 2. Hemoptysis The nurse uses palpation during respiratory assessment to determine which clinical finding? 1. Tracheal position 2. Bronchovesicular sounds 3. Lung density 4. Adventitious sounds 1. Tracheal position The nurse educator is teaching a student nurse how to auscultate the lungs. Which action by the student nurse indicates the need for further education? 1. Listening to sound over the bony structures 2. Asking the patient to sit in an upright position 3. Instructing the patient to breathe slowly through mouth 4. Beginning auscultation from lung apices and moving toward intercostal spaces 1. Listening to sound over the bony structures The nurse uses which the term to describe abnormal breath sounds? 1. Vesicular 2. Bronchial 3. Adventitious 4. Bronchovesicular 3. Adventitious Which percussion sound does the nurse expect when conducting percussion between the ribs during a respiratory assessment? 1. Flat 2. Dull 3. Tympany 4. Resonance 4. Resonance When percussing the patient's lung fields, the nurse notes a long, hollow, loud pitched sound over the chest. The nurse uses which term to describe this in the health record? 1. Dull 2. Tympany 3. Resonance 4. Hyperresonance 3. Resonance The nurse correlates which percussion sound to the patient diagnosed with emphysema? 1. Flat 2. Dull 3. Tympany 4. Hyperresonance 4. Hyperresonance Where does the nurse auscultate bronchial vesicular sounds? 1. Neck 2. Trachea 3. First to second intercoastal spaces 4. Peripheral lung fields 3. First to second intercostal spaces The nurse is assessing a patient who is admitted with pulmonary edema and presents with a persistent cough. Which assessment finding is consistent with this diagnosis? 1. Foul-smelling sputum 2. Wheezing 3. Coarse crackles 4. Stridor 3. Coarse crackles While auscultating a patient's chest, the nurse notes wheezing, and correlates this finding with which disorder? 1. Bronchitis 2. Pleural effusion 3. Pulmonary edema 4. Chronic obstructive pulmonary disease 4. Chronic obstructive pulmonary disease Before an arterial blood gas is collected from the radial artery, an Allen's test is preformed to access the patency of which artery? 1. Brachial 2. Medial 3. Radial 4. Ulnar 4. Ulnar A patient is admitted for evaluation of complaints of difficulty breathing and is scheduled for a sputum study to assist in providing data for which diagnosis? 1. Asthma 2. Lung cancer 3. Bacterial lung infection 4. Chronic obstructive pulmonary disease 3. Bacterial lung infection How does the nurse interpret these arterial blood gas results? pH 7.48 PaCO2 30 mm Hg HCO3 24 mEq/L 1. Metabolic acidosis 2. Respiratory acidosis 3. Metabolic alkalosis 4. Respiratory alkalosis 4. Respiratory alkalosis The nurse correlated respiratory acidosis in a patient with which arterial blood gas result? 1. pH 7.50 2. PaCO2 50 mm Hg 3. PaO2 80 mm Hg 4. HCO3- 20 mEq/L 2. PaCO2 50 mm Hg In reviewing capnography data, the nurse monitors for increased end-tidal volume CO2 in patients with which disorder? 1. Sepsis 2. Hypothermia 3. Esophageal intubation 4. Cardiac arrest 1. Sepsis A patient is scheduled for pulmonary function testing. Which nursing action is most appropriate for the patient? 1. Assessing for respiratory distress 2. Scheduling the test after a meal 3. Providing rest before the procedure 4. Administering an inhaled bronchodilator 6 hours before procedure 1. Assessing for respiratory distress The nurse is providing care to a patient who will need a bronchoscopy. Which patient statement indicates that pre-procedure teaching was effective? 1. "I will be awake and fully conscious during the procedure." 2. "I will require mechanical ventilation after the procedure." 3. "I will need to have my prothrombin time drawn after the test." 4. "I will abstain from eating or drinking for 8 hours before the procedure." 4. "I will abstain from eating or drinking for 8 hours before the procedure." The nurse prepares the patient for which diagnostic procedure that is used to remove pleural fluid for analysis? 1. Lung biopsy 2. Bronchoscopy 3. Thoracentesis 4. Sputum studies 3. Thoracentesis The nursing diagnosis "Ineffective Breathing Pattern related to decreased chest wall compliance" is most relevant to the older adult patient with which condition? 1. Decreased diaphragmatic strength 2. Delays in gas exchange 3. Depressed cough reflex 4. Kyphosis 4. Kyphosis The nurse provides care to patients in the urgent care center. Which patient has the greatest risk for developing influenza? 1. A patient aged 26 years with a history of systemic lupus erythematosus (SLE) who works as an accountant 2. A patient aged 44 years who is a nurse 3. A patient aged 60 years with a history of asthma 4. A patient aged 66 years with a history of diabetes mellitus 4. A patient aged 66 years with a history of diabetes mellitus Which statement by the patient recently diagnosed with an influenza infection indicates that teaching was effective? 1. "I am infectious for 4 days." 2. "I am infectious for up to 10 days." 3. "I am not infectious now that I am on antibiotics." 4. "I am not infectious unless I cough up a lot of secretions." 2. "I am infectious for up to 10 days." The nurse working in the emergency department recognizes that the results of a rapid influenza diagnostic test (RIDT) is usually available within which time frame? 1. 30 minutes 2. 60 minutes 3. 12 hours 4. 24 hours 1. 30 minutes The nurse is assessing several patients at a community clinic. The nurse questions administration of the annual influenza vaccination in which patient? 1. A 3-year-old with cystic fibrosis 2. A 25-year-old pregnant woman at 20 weeks' gestation 3. A 35-year-old man with a severe allergy to eggs 4. A 65-year-old woman with diabetes 3. A 35-year-old man with a severe allergy to eggs The nurse provides education to a patient who is prescribed an antiviral medication, oseltamivir (Tamiflu), for the treatment of influenza. Which patient statement indicates to the nurse a correct understanding of the administration of this medication? 1. "This medication is administered by an IV." 2. "This medication is administered by mouth." 3. "This medication is administered by injection." 4. "This medication is administered by inhalation." 2. "This medication is administered by mouth." The nurse correlates which clinical manifestation as the earliest compensatory mechanism in the patient with influenza? 1. Oliguria 2. Tachycardia 3. Tachypnea 4. Fever 3. Tachypnea The patient recently released from the hospital after recovering from complications related to influenza is being seen in the outpatient clinic. Which patient statement indicates the need for further intervention? 1. "I went back to work." 2. "I am drinking at least 8 glasses of water daily. " 3. "I continue to wake up coughing at night." 4. "I only had a low-grade fever once since I left the hospital." 3. "I continue to wake up coughing at night." The nurse questions which order for the patient admitted with the flu who is experiencing tachypnea? 1. Maintain adequate hydration. 2. Keep the head of the bed elevated. 3. Teach the patient coughing, deep breathing, and hydration. 4. Prepare the patient for intubation. 4. Prepare the patient for intubation The nurse is planning care for a patient diagnosed with influenza. Which intervention by the nurse is the priority when planning this patient's care? 1. Restricting all visits from family and friends 2. Providing staff with N95 mask respirators 3. Placing the patient in a negative air flow room 4. Placing the patient on droplet precaution 4. Placing the patient on droplet precaution Which statement by the patient being discharged after hospitalization for influenza indicated the need for further teaching? 1. "I do not need to get a flu shot next year because I am now immune." 2. "I still need to get flu shots every year." 3. "I understand that the flu vaccine changes every year." 4. "I need to get my flu shot every year in the early fall." 1. "I do not need to get a flu shot next year because I am now immune." The nurse is preparing an educational program pneumonia and includes information about which pathogen that is the major pathogen associated with hospital-acquired pneumonia (HAP)? 1. Haemophilus influenzae 2. Mycoplasma pneumoniae 3. Pseudomonas aeruginosa 4. Streptococcus pneumoniae 3. Pseudomonas aeruginosa How does the nurse interpret the following arterial blood gases in the patient admitted with influenza? pH 7.48 PaO2 85 mm Hg PaCO2 30 mm Hg HCO3 24 mEq/L 1. Respiratory alkalosis 2. Respiratory acidosis 3. Hypoxemia 4. Normal arterial blood result 1. Respiratory alkalosis In reviewing arterial blood gas results on a patient admitted with a severe influenza infection, the nurse correlates which value to the patients' respiratory acidosis? 1. pH 7.50 2. PaO2 75 mm Hg 3. PaCO2 50 mm Hg 4. O2 Saturation 88% 3. PaCO2 50mm Hg The nurse recognizes which medication is indicated to treat community-acquired pneumonia in the patient who was previously healthy and has not received antibiotics in the last 3 months? 1. β-Lactam antibiotics 2. Macrolides 3. Respiratory fluoroquinolones 4. Vancomycin 2. Macrolides The nurse is caring for a patient who was recently treated for an empyema that developed secondary to pneumonia. Which procedure does the nurse prepare the patient to decrease recurrence once the empyema has been drained? 1. Bronchoscopy 2. Chest tube insertion 3. Pleurodesis 4. Thoracentesis 3. Pleurodesis The nurse develops the nursing diagnosis, "Ineffective Airway Clearance related to thick purulent secretions." This nursing diagnosis is most relevant to the patient with which medical diagnosis? 1. Tuberculosis 2. Bacterial pneumonia 3. Influenza A 4. Influenza C 1. Tuberculosis On assuming care for a patient being treated for bacterial pneumonia, which assessment finding requires immediate attention by the nurse? 1. Fever 2. Productive cough 3. Restlessness 4. Arthralgia 3. Restlessness The nurse is caring for a patient hospitalized for a severe bacterial pneumonia with a left lung infiltration. In what position does the nurse place the patient to maximize perfusion to functional alveolar units? 1. Prone 2. Supine with head of bed elevated 30 degrees 3. On the left side 4. On the right side 4. On the right side The nurse monitors for which clinical manifestation in the patient admitted with tuberculosis? 1. Greenish-colored sputum 2. Rust-colored sputum 3. Whitish-colored sputum 4. Yellowish-colored sputum 2. Rust-colored sputum The nurse is assessing a patient who is diagnosed with tuberculosis. Which assessment finding correlates with this diagnosis? 1. Wheezing 2. Hemoptysis 3. Yellowish sputum 4. Slightly whitish sputum 2. Hemoptysis On assuming care for a patient being treated for tuberculosis, which assessment finding requires immediate attention by the nurse? 1. Dyspnea 2. Fatigue 3. Night sweats 4. Rust-colored sputum 1. Dyspnea The nurse reads tuberculin skin test (TST) results for a group of patients. Which patient does the nurse document as a positive result in the medical record? 1. The adult patient diagnosed with HIV whose induration is 3 mm. 2. The adult who recently had contact with a person with tuberculosis whose induration is 4 mm. 3. The patient who uses intravenous (IV) drugs whose induration is 11 mm. 4. The adult who recently immigrated from a high-prevalence country whose induration is 8 mm. 3. The patient who uses intravenous (IV) drugs whose induration is 11 mm The nurse working in the community health clinic places a purified protein derivative (PPD, or Mantoux) test on an adult's forearm and instructs him to return when for reading of the response? 1. The following day 2. Between 24 and 48 hours after placement of the PPD 3. Between 48 and 72 hours after placement of the PPD 4. Between 72 and 96 hours after placement of the PPD 3. Between 48 and 72 hours after placement of the PPD The nurse is caring for a patient who is admitted to the unit with tuberculosis (TB). The patient is placed in isolation. To protect the caregivers and other patients on the unit, which type of isolation room is most appropriate? 1. Single-door room with positive air flow (air flows out of the room) 2. Isolation room with an anteroom and negative air flow (air flows into the room) 3. Isolation room with an anteroom and normal airflow 4. Single-door room with normal airflow 2. Isolation room with an anteroom and negative air flow (air flows into the room) Which statement made by the patient with an active tuberculosis (TB) infection who is discharged to home receiving directly observed therapy indicates that teaching was effective? 1. "The home-health nurse will come to my home daily to make sure that I take my medications." 2. "I need to be on home isolation for about 2 weeks." 3. "I only have to take these medications for about 6 months." 4. "I will not need to be tested for TB after the infection is cured." 1. "The home-health nurse will come to my home daily to make sure that I take my medication." The nurse is assessing a patient who was recently diagnosed with chronic rhinitis. Which statement by the patient is most consistent with this diagnosis? 1. "My nasal drainage is always clear and watery." 2. "My nose has been runny for 4 weeks." 3. "My nasal drainage has gotten thicker over the last 12 weeks." 4. "I always get a runny nose in the spring when everything blooms." 3. "My nasal drainage has gotten thicker over the last 12 weeks." The nurse correlates nasal itching, sneezing, nasal congestion, and rhinorrhea that is thin and clear to which disorder? 1. Acute bacterial rhinosinusitis (ABRS) 2. Acute viral rhinosinusitis 3. Chronic rhinitis 4. Rhinitis 4. Rhinitis The nurse is providing care to a patient who is diagnosed with rhinitis and prescribed a first generation antihistamine. The nurse includes data regarding which medication? 1. Loratadine 2. Fluticasone 3. Guaifenesin 4. Diphenhydramine 4. Diphenhydramine The nurse is providing care to a patient who is diagnosed with rhinitis and prescribed a second generation antihistamine. The nurse includes data regarding which medication? 1. Loratadine 2. Fluticasone 3. Guaifenesin 4. Diphenhydramine 1. Loratadine The nurse provides education to a patient who is being treated for rhinitis. Which patient statement indicates the need for further teaching? 1. "I will use my nasal decongestant spray every day." 2. "I will make an appointment if my nasal drainage is yellow." 3. "I will avoid spending time outside when pollen levels are increased." 4. "I will cover my cough with my arm to decrease the spread of germs." 1. "I will use my nasal decongestant spray every day." Which statement by the patient being treated with intranasal corticosteroids indicates that teaching was effective regarding this medication? 1. "I will have to monitor my glucose levels because of this medication." 2. "I may gain a few pounds because of this medication." 3. "I will have to gradually wean myself from this medication." 4. "I may not see result from this medication for a few days or weeks." 4. "I may not see results from this medication for a few days or weeks." In reviewing the prescribed medications for a patient being treated for rhinitis, the nurse correlates patient complaints of sleepiness, dry mouth eyes and mouth, and constipation to which medication? 1. Alavert 2. Benadryl 3. Claritin 4. Flonase 2. Benadryl The nurse recognizes which patient at greatest risk for chronic rhinosinusitis? 1. Female patient with history of otorrhea 2. Female patient with history of nasal polyps 3. Male patient who has a tonsillectomy at age 12 4. Male patient with history of nasal trauma 2. Female patient with history of nasal polyps Which patient statement regarding the use of a normal saline nasal rinse requires intervention by the nurse? 1. "I will lean over the sink with my head tilted to one side." 2. "I will insert the spout of the irrigating device in the upper nostril." 3. "I will slowly pour the normal saline into the nostril while breathing through my mouth." 4. "I will allow fluid to drain out the upper nostril to remove excess mucous from my nose." 4. "I will allow fluid to drain out the upper nostril to remove excess mucus from my nose." The nurse is providing care to a patient who is diagnosed with rhinosinusitis and prescribed fluticasone. The nurse recognizes that the rationale for this medication is which of the following actions? 1. Decreasing sinus drainage 2. Decreasing inflammation 3. Decreasing viscosity of secretions 4. Decreasing risk of infection 2. Decreasing inflammation The nurse is providing care to a patient who is diagnosed with rhinosinusitis and prescribed azelastine. The nurse recognizes that the rationale for this medication is which of the following actions? 1. Decreasing fever 2. Decreasing inflammation 3. Decreasing nasal drainage 4. Decreasing viscosity of secretions 2. Decreasing inflammation The nurse is caring for a patient who has developed rhinitis medicamentosa. The nurse correlates this finding to which treatment used to in the management of rhinosinusitis? 1. Intranasal corticosteroids 2. Topical decongestants 3. Normal saline irrigation 4. Oral antibiotics 2. Topical decongestants Which patient does the nurse assess to have the greatest risk for obstructive sleep apnea? 1. 35-year-old obese female with a history of type 2 diabetes 2. 42-year-old obese male with history of cigarette smoking 3. 55-year-old obese female who works as an administrative assistant 4. 68-year-old obese male who worked in a chemical plant for 45 years 2. 42-year-old obese male with history of cigarette smoking Which diagnostic study is the most effective in determining whether a patient has obstructive sleep apnea? 1. Arterial blood gas 2. Bronchoscopy 3. Computed tomography (CT) of the chest 4. Polysomnography 4. Polysomnography In assessing the patient immediately after extubation, which finding requires an immediate intervention? 1. Respiratory rate of 22 2. Adventitious breath sounds 3. Stridor 4. Tachycardia 3. Stridor Which statement by a patient scheduled for a total laryngectomy indicates the need for further teaching? 1. "I will have to eat through a tube in stomach for the rest of my life." 2. "I will not be able to speak after the surgery." 3. "I will be able to eat and drink once I heal from the surgery." 4. "I will have a permanent tracheotomy." 1. "I will have to eat through a tube in stomach for the rest of my life." Which prescribed first-line therapy does the nurse include in a teaching session for a patient who wants to quit smoking? 1. The use of oral clonidine 2. The use of nicotine patches 3. The importance of taking daily walks 4. The importance of behavioral therapy 2. The use of nicotine patches The nurse provides dietary teaching for a patient who is being treated for laryngeal cancer. Which patient statement indicates a need for additional information? 1. "I should eat foods that are soft and easy to swallow." 2. "I should eat three large high-calorie meals each day." 3. "I will try to drink a liquid nutritional supplement each day." 4. "I will avoid spicy foods as they may increase my pain with swallowing." 2. "I should eat three large high-calorie meals each day." The nurse is providing education to the patient who is receiving treatment for laryngeal cancer. Which patient statement regarding nutrition requires further education from the nurse? 1. "I will eat small, frequent meals to ensure I get enough calories each day." 2. "I can eat any type of food as long as it is easy to swallow." 3. "Liquid supplements are easy to swallow and will increase my caloric intake." 4. "I will eat foods that taste good and are easy to swallow to get enough calories each day." 2. "I can eat any type of food as long as it is easy to swallow." The nurse is providing care to a patient receiving radiation in the treatment of laryngeal cancer. Which patient statement indicates the need for further education regarding radiation treatments? 1. "My skin may become red, tender, and peel." 2. "I should avoid the sun while I am receiving this therapy." 3. "I will wear soft, loose-fitting clothing made of cotton to limit irritation." 4. "My therapy includes washing my skin with a deodorant soap and applying lotion." 4. "My therapy includes washing my skin with a deodorant soap and applying lotion." The nurse is providing education to a patient receiving radiation therapy for the treatment of laryngeal cancer. Which patient statement indicates the need for further education regarding oral care? 1. "I should increase my oral intake of water." 2. "I will avoid spicy foods." 3. "I can chew gum to decrease dry mouth." 4. "I should use a firm-bristle toothbrush to clean my teeth." 4. "I should use a firm-bristle toothbrush to clean my teeth." Which assessment data collected by the nurse requires an immediate intervention in the patient with laryngeal trauma? 1. Tachypnea 2. Bradycardia 3. Hypotension 4. Complaints of throat pain 1. Tachypnea Which is the priority nursing diagnosis for a patient who experiences laryngeal trauma? 1. Ineffective Breathing Pattern 2. Impaired Swallowing 3. Ineffective Airway Clearance 4. Impaired Gas Exchange 3. Ineffective airway clearance In providing care to a patient with laryngeal trauma, which order does the nurse question? 1. Place an intubation tray at the bedside 2. Maintain NPO status 3. Elevate the head of the 45 degrees or higher 4. Administer warm, humidified air 4. Administer warm, humidified air Friends of a patient hospitalized with asthma would like to bring the patient a gift. Which gift would the nurse recommend for this patient? 1. A basket of flowers 2. A stuffed animal 3. Fruit and candy 4. A book 4. A book The nurse develops the nursing diagnosis "Ineffective Airway Clearance related to intermittent, reversible airway obstruction secondary to bronchoconstriction and airway inflammation." For which disorder is this nursing diagnosis most relevant? 1. Asthma 2. Bronchiectasis 3. Chronic bronchitis 4. Emphysema 1. Asthma Which statements by a patient with asthma indicates effective teaching? 1. "We'll use the fireplace to keep the house warm in the winter." 2. "We will replace the carpet in our bedroom with tile." 3. "We'll make sure that we dust our plants frequently." 4. "We're glad we can keep our dog." 2. "We will replace the carpet in our bedroom with title." The nurse monitors for which therapeutic effect when administering leukotriene receptor antagonists to patients diagnosed with asthma? 1. Cause bronchodilation of the airways 2. Decrease viscosity of secretions 3. Decrease work of breathing by relaxing muscles around bronchi 4. Inhibit the inflammatory process 4. Inhibit the inflammatory process In administering bronchodilator therapy to a patient with asthma, the nurse correlates the effectiveness of this classification of medication to which mechanism of action? 1. Bronchodilators widen the airways because they act on the parasympathetic nervous system. 2. Bronchodilators widen the airways because they stimulate the sympathetic nervous system. 3. Bronchodilators decrease inflammation of the airways. 4. Bronchodilators decrease the production of mucus that narrows the airways. 2. Bronchodilators widen the airways because they stimulate the sympathetic nervous system In providing care to a patient admitted with an acute asthma exacerbation, the nurse prepares which "rescue" medication for administration first? 1. Inhaled anti-inflammatories 2. Mucolytics 3. Long-acting beta2-adrenergic agonists 4. Short-acting beta2-adrenergic agonists 4. Short-acting beta2-adrenergic agonists The nurse finds a patient admitted with asthma and pneumonia restless, anxious, complaining of increasing difficulty breathing, and stridor. Because of suspected status asthmaticus, an arterial blood gas is ordered. Which result requires an immediate intervention? 1. pH 7.30 2. PaCO2 48 mm Hg 3. PaO2 50 mm Hg 4. SpO2 88% 3. PaCO2 50mm Hg The nurse is providing care to a patient admitted after experiencing an acute asthma attack. Which assessment findings indicate the need for an immediate intervention? 1. Retractions and fatigue 2. Tachycardia and tachypnea 3. Inaudible breath sounds 4. Diffuse wheezing and the use of accessory muscles when inhaling 3. Inaudible breath sounds The nurse is caring for a patient newly diagnosed with asthma. Which assessment data indicate the need for an immediate intervention? 1. Diminished breath sounds 2. Decreased respiratory rate 3. Increased crackles 4. Increased respiratory rate 1. Diminished breath sounds Patients with asthma initially develop respiratory alkalosis. Which arterial blood gas value is consistent with this acid-base disorder? 1. pH 7.32 2. PaCO2 30 mm Hg 3. PaO2 78 mm Hg 4. SpO2 90% 2. PaCO2 30 mmHg The nurse provides education to a patient who is prescribed an aerochamber for the treatment of asthma. Which patient statement indicates the need for additional teaching? 1. "I will place the mouthpiece over my nose and mouth." 2. "I should hear a whistling sound as I inhale the medication." 3. "I should wait a few seconds before I administer the second dose." 4. "I will hold my breath for 10 seconds after inhaling the medication." 2. "I should hear a whistling sound as I inhale the medication." The nurse develops the nursing diagnosis "Ineffective Airway Clearance related to increased mucus production secondary to chronic inflammation of small airways." For which disorder is this nursing diagnosis most relevant? 1. Asthma 2. Chronic bronchitis 3. Cystic fibrosis 4. Emphysema 2. Chronic bronchitis The nurse develops the nursing diagnosis "Impaired Gas Exchange related to decreased lung elasticity and hyperinflation of the alveoli secondary to exposure to inhaled pollutants." For which disorder is the nursing diagnosis most relevant? 1. Asthma 2. Chronic bronchitis 3. Cystic fibrosis 4. Emphysema 4. Emphysema Which clinical manifestation in the patient with chronic obstructive pulmonary disease (COPD) is more indicative of emphysema? 1. Cyanosis 2. Obese 3. Reddish complexion 4. Non-productive cough 3. Reddish complexion The nurse is providing care to a patient diagnosed with emphysema. Which clinical manifestation does the nurse correlate with this diagnosis? 1. Tachycardia 2. Cough 3. Barrel chest 4. Wheezing 3. Barrel chest The nurse correlates which data from a patient's history to a diagnosis of bronchitis? 1. A history of rhinitis 2. A history of eczema 3. A family history of allergies 4. A history of progressive dyspnea 4. A history of progressive dyspnea The nurse teaches a patient how to implement pursed-lip breathing. Which patient statement indicates a need for additional instruction? 1. "I will sit up with my shoulders relaxed." 2. "I will be sure to exhale twice as long as I inhale." 3. "I will inhale through my mouth while slowly counting." 4. "I will exhale through my mouth as if I was blowing out candles." 3. "I will inhale through my mouth while slowly counting." A patient diagnosed with chronic obstructive pulmonary disease (COPD) has a pulse oximetry reading of 93%, increased red blood and white blood cell count, temperature of 101°F, pulse 100 bpm, respirations 35 bpm, and a chest x-ray examination that showed a flattened diaphragm with infiltrates. Based on this data, which prescription does the nurse question for this patient? 1. Antibiotic therapy 2. Nonsteroidal anti-inflammatory agents 3. Oxygen by nasal cannula at 3 to 4 L/minute 4. Bronchodilators such as an adrenergic stimulating drugs or anticholinergic agents 3. Oxygen by nasal cannula at 3 to 4 L/minute The nurse correlates which diagnostic result as consistent with the diagnosis of cystic fibrosis? 1. Elevated serum chloride 2. Elevated sodium levels in sweat 3. Decreased urine chloride 4. Decreased urine specific gravity 2. Elevated sodium levels in sweat The nurse monitors for which gastrointestinal clinical manifestations in the patient diagnosed with cystic fibrosis? 1. Diarrhea 2. Hematemesis 3. Melena 4. Steatorrhea 4. Steatorrhea Which statement by the patient regarding the treatment for cystic fibrosis indicates the need for further teaching? 1. "Taking CFTR modulators will cure my cystic fibrosis." 2. "There are medications that will decrease the viscosity of the secretions." 3. "I may need to take vitamins to support my nutritional needs." 4. "I may also have to take pancreatic enzymes for nutritional purposes." 1. "Taking CFTR modulators will cure my cystic fibrosis." Although all of these patients do not currently smoke cigarettes, the nurse recognizes that which patient is at greatest risk factor for the development of lung cancer? 1. 60-year-old black male with a history of smoking in his teens 2. 64-year-old white female who went to an elementary school that had asbestos 3. 68-year-old black male with a 40 pack-year history of smoking 4. 72-year-old white male with a 10 pack-year history of smoking 3. 68-year-old black male with a 40 pack-year history of smoking The nurse is caring for a patient in a community clinic who wishes to quit smoking. The patient asks the nurse, "If I quit smoking, will my risk of lung cancer be the same as a nonsmoker?" Which is the best response by the nurse? 1. "No one knows for sure what the risk is for someone who quits smoking." 2. "Your risk of lung cancer will be equal to that of a nonsmoker." 3. "Your risk of lung cancer will decline if you quit, but it will remain higher than a nonsmoker's." 4. "Your risk of lung cancer will never drop because the damage has already been done." 3. "Your risk of lung cancer will decline if you quit, but it will remain higher than a nonsmoker's." The nurse is caring for an older adult patient who is very thin and emaciated. The patient reports new onset of shortness of breath. A chest x-ray examination reveals a spot on the lungs that the physician believes is an inoperable lung cancer. Because of the patient's poor nutritional status, chemotherapy is not an option. The healthcare provider also believes that the location of the cancer would make radiation therapy unsuccessful. In advocating for this patient, what approach does the nurse collaborate with the healthcare team to offer the patient? 1. Provide palliative care to keep the patient comfortable without diagnostic testing 2. Perform any procedure necessary to diagnose the patient properly 3. Promote the use of blood tests to diagnose the suspected cancer 4. Determine the patient's and family's wishes regarding diagnostic testing 4. Determine the patient's and family's wishes regarding diagnostic testing A client in labor after 32 weeks' gestation is eager to deliver. Which client statement indicates that teaching provided about fetal development was effective? 1. "The baby's lungs are well developed now, but he will be at increased risk for SIDS if I deliver early." 2. "We should try to stop this labor now because the baby will be born with sleep apnea if I deliver this early." 3. "If I deliver this early my baby is at risk for respiratory distress syndrome, a condition that can be life threatening." 4. "Thanks for reassuring me; I was pretty sure there isn't much risk to the baby this far along in my pregnancy." 3. "If I deliver this early my baby is at risk for respiratory distress syndrome, a condition that can be life threatening." The nurse is caring for a patient who is experiencing dyspnea. Which position would be most effective if incorporated into the patient's care? 1. Supine 2. Head of bed elevated 80° 3. Head of bed elevated 30° 4. Lying on left side 2. Head of bed elevated 80° While a patient is receiving hygiene care, the chest tube becomes disconnected from the water-seal chest drainage system (CDU). Which action should the nurse take immediately? 1. Clamp the chest tube close to the insertion site. 2. Set up a new drainage system and connect it to the chest tube. 3. Have the patient take and hold a deep breath while the nurse reconnects the tube to the CDU. 4. Place the disconnected end nearest the patient into a bottle of sterile water. 4. Place the disconnected end nearest the patient into a bottle of sterile water. The nurse administers an antitussive/expectorant cough preparation to a patient with bronchitis. Which response indicates to the nurse that the medication is effective? 1. The amount of sputum decreases with each dose administered. 2. Cough is completely suppressed, and the patient is able to sleep through the night. 3. Dry, unproductive cough is reduced, but voluntary coughing is more productive. 4. Involuntary coughing produces large amounts of thick yellow sputum. 3. Dry, unproductive cough is reduced, but voluntary coughing is more productive. A client with pulmonary hypertension and right-sided heart failure has conversational dyspnea and shortness of breath. What is the first action the nurse should take? 1. Review and implement the primary care provider’s prescriptions for treatments. 2. Perform a quick physical examination of breathing, circulation, and oxygenation. 3. Gather a thorough medical history, including current symptoms, from the family. 4. Administer oxygen to the patient through a nasal cannula. 2. Perform a quick physical examination of breathing, circulation, and oxygenation. A client with a closed head injury has a respiratory pattern that progressively increases and then decreases in depth, followed by a period of apnea. What is this client's breathing pattern? 1. Biot's breathing 2. Kussmaul's respirations 3. Sleep apnea 4. Cheyne-Stokes respirations 4. Cheyne-Stokes respirations A patient with chronic obstructive pulmonary disease (COPD) is prescribed O2 at 24% FIO2. What is the most appropriate oxygen delivery method for this patient? 1. Nonrebreather mask 2. Nasal cannula 3. Partial rebreather mask 4. Venturi mask 4. Venturi mask Which information provides the most reliable data about the effectiveness of airway suctioning? 1. The amount, color, consistency, and odor of secretions 2. The patient's tolerance for the procedure 3. Breath sounds, vital signs, and pulse oximetry before and after suctioning 4. The number of suctioning passes required to clear secretions 3. Breath sounds, vital signs, and pulse oximetry before and after suctioning What is the rationale for wrapping petroleum gauze around a chest tube insertion site? 1. Prevents air from leaking around the site 2. Prevents infection at the insertion site 3. Absorbs drainage from the insertion site 4. Protects the tube from becoming dislodged 1. Prevents air from leaking around the site A client with a tracheostomy being mechanically ventilated has a pulse oximetry reading of 85%, heart rate of 113 beats/min, and respiratory rate of 30 breaths/min. The client is restless, and crackles and rhonchi are auscultated over both lungs. Which action should the nurse take? 1. Call the respiratory therapist to check the ventilator settings. 2. Provide endotracheal suctioning. 3. Provide tracheostomy care. 4. Notify the physician of the patient's signs of fluid overload. 2. Provide endotracheal suctioning. Chest percussion and postural drainage would be an appropriate intervention for which condition? 1. Congestive heart failure 2. Pulmonary edema 3. Pneumonia 4. Pulmonary embolus 3. Pneumonia Which blood level normally provides the primary stimulus for breathing? 1. pH 2. Oxygen 3. Bicarbonate 4. Carbon dioxide 4. Carbon dioxide A 62-year-old man with emphysema does not understand the need to stop smoking at this age because lung problems already exist. Which would be the best response to his statement? 1. "You should quit so your family does not get sick from exposure to secondhand smoke." 2. "You will need to use oxygen, but remember it is a fire hazard to smoke with oxygen in your home." 3. "Once you stop smoking, your body will begin to repair some of the damage to your lungs." 4. "You should ask your primary care provider for a prescription for a nicotine patch to help you quit." 3. "Once you stop smoking, your body will begin to repair some of the damage to your lungs." The nurse administers intravenous morphine sulfate to a patient for pain control. For which adverse effect should the nurse monitor this patient? 1. Decreased heart rate 2. Muscle weakness 3. Decreased urine output 4. Respiratory depression 4. Respiratory depression When using sterile technique to perform tracheostomy care of a new tracheostomy, which action is correct? 1. Apply sterile gloves. 2. Place the patient in semi-Fowler's position, if possible. 3. Clean the stoma under the faceplate with hydrogen peroxide. 4. Cut a slit in sterile 4 × 4 gauze halfway through to make a dressing. 2. Place the patient in semi-Fowler's position, if possible. A patient has just had a chest tube inserted to dry-seal suction drainage. Which is a correct nursing intervention for maintenance? 1. Keep the head of the bed flat for 6 hours. 2. Immobilize the patient's arm on the affected side. 3. Keep the drainage system lower than the insertion site. 4. Drain condensation into the humidifier when it collects in the tubing. 3. Keep the drainage system lower than the insertion site. The nurse examines the site of a client's tuberculin skin test as being 5 mm induration and documents that the test is positive. Which information in the client's history did the nurse use to make this clinical determination? 1. HIV positive 2. Type 2 diabetes mellitus 3. Lives in a skilled nursing facility 4. Recent immigrant to the United States 1. HIV positive A client’s pulse oximetry reading is 90%. What action should the nurse take first? 1. Raise the head of the bed. 2. Prepare to administer oxygen. 3. Notify the healthcare provider. 4. Move the sensor to another area. 4. Move the sensor to another area. The nurse notes that a client has a prescription for a peak expiratory flow meter. For which health problem should the nurse prepare teaching for this client? 1. Asthma 2. Pneumonia 3. Emphysema 4. Pulmonary edema 1. Asthma A client is coughing and has bilateral rhonchi throughout the lung fields. Which nursing diagnosis is most appropriate for these assessment findings? 1. Impaired Gas Exchange 2. Ineffective Airway Clearance 3. Ineffective Breathing Pattern 4. Impaired Spontaneous Ventilation 2. Ineffective Airway Clearance