MSN377 EXAM 3 –CH 27,65,67 QUESTIONS AND ANSWERS VERIFIED 100% CORRECT

MSN377 EXAM 3 –CH 27,65,67 QUESTIONS AND ANSWERS VERIFIED 100% CORRECT The nurse administers prescribed therapies for a patient with for pulmonate and right-sided heart failure. Which assessment could be used to 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. Monitor for elevated white blood cell count. - ANSWER -ANS: A Cor pulmonale is right ventricular failure caused by pulmonary hypertension, so clinical manifestations of right ventricular failure such as peripheral edema, jugular venous distention, and right upperquadrant abdominal tenderness would be expected. Crackles in the lungs are likely to be heard with left-sided heart failure. Findings in cor pulmonale include evidence of right ventricular hypertrophy on electrocardiography and an increase in intensity of the second heart sound. Which action should the nurse take to prepare a patient with a pleural effusion for a thoracentesis? a. Remind the patient not to eat or drink for 6 hours b. Start a peripheral IV line to administer sedation c. Position the patient sitting up on the side of the bed d. Obtain a collection device to hold 3 liters of pleural fluid - ANSWER -ANS: C When the patient is sitting up, fluid accumulates in the pleural space at the lung bases and can more easily be located and removed. The patient does not usually require sedation for the procedure, and there are no restrictions on oral intake because the patient is not sedated or unconscious. Usually only 1000 to 1200 mL of pleural fluid is removed at one time. Rapid removal of a large volume can result in hypotension, hypoxemia, or pulmonary edema. A patient who has just been admitted with community-acquired pneumococcal pneumonia has a temperature of 101.6 F with a frequent cough and severe pleuritic chest pain. Which prescribed medication should the nurse give first? a. Codeine b. Guaifenesin c. Acetaminophen (Tylenol) d. Piperacillin/tazobactam (Zosyn) - ANSWER -ANS: D Early initiation of antibiotic therapy has been shown to reduce mortality. The other medications are also appropriate and should be given as soon as possible, but the priority is to start antibiotic therapy. The nurse notes that a patient has incisional pain, a poor cough effort, and scattered coarse crackles after a thoracotomy. Which action should the nurse take first? a. Assist the patient to sit upright in a chair b. Splint the patient's chest during coughing c. Medicate the patient with prescribed morphine d. Observe the patient use the incentive spirometer - ANSWER -ANS: C A major reason for atelectasis and poor airway clearance in patients after chest surgery is incisional pain (which increases with deep breathing and coughing). The first action by the nurse should be to medicate the patient to minimize incisional pain. The other actions are all appropriate ways to improve airway clearance but should b done after the morphine is given. The nurse is caring for a patient with idiopathic pulmonary arterial hypertension (IPAH). Which assessment information requires the most immediate action by the nurse? a. The O2 saturation is 90% b. The blood pressure is 98/56 mmHg c. The epoprostenol (Floloan) infusion is disconnected d. The international normalized ration (INR) is prolonged - ANSWER - ANS: C The half-life of epoprostenol (Floloan) is 6 minutes, so the nurse will need to restart the infusion as soon as possible to prevent rapid clinical deterioration. The other data also indicate a need for ongoing monitoring or intervention, but the priority action is to reconnect the infusion. A patient who was admitted the previous day with pneumonia reports a sharp pain of 7 "whenever I take a deep breath." Which action will the nurse take next? a. Auscultate for breath sounds b. Administer as-needed morphine c. Have the patient cough forcefully d. Notify the patient's health care provider - ANSWER -ANS: A Patient's statement indicates that pleurisy or a pleural effusion may have developed, and the nurse will need to listen for a pleural friction rub and decreased breath sounds. Assessment should occur before administration of pain medications. The patient is unlikely to be able to cough forcefully until pain medication has been administered. The nurse will want to obtain more assessment data before calling the health care provider. A patient has acute bronchitis with a nonproductive cough and wheezes. Which topic should the nurse plan to include in the teaching plan? a. Purpose of antibiotic therapy b. Ways to limit oral fluid intake c. Appropriate use of cough suppressants