To Do: PNVN 1631 Module 5 Exam #2 Respiratory__PNVN1631 Medical Surgical Nursing I (Score for this attempt: 78 out of 80)

To Do: PNVN 1631 Module 5 Exam #2 Respiratory Due Oct 25 at 10:30am Points 80 Questions 80 Available Oct 25 at 9:45am - Oct 25 at 10:30am 45 minutes Time Limit 90 Minutes Allowed Attempts Unlimited Instructions This quiz was locked Oct 25 at 10:30am. Attempt History Attempt Time Score LATEST Attempt 1 21 minutes 78 out of 80 Score for this attempt: 78 out of 80 Submitted Oct 25 at 10:44am This attempt took 21 minutes. Respiratory Test: Read the questions carefully and choose the best option(s) that answer the questions. Be mindful of your time. You are given 90 minutes to complete the test. Good luck! Question 1 1 / 1 pts Which test is a quick and reliable aid to diagnosis latent TB? TB tine test PPD skin test QFT-G Sputum smearsSputum smears, cultures and PPD skin test are still done. However, QFT-G offers a quick and reliable diagnosis for the patient and health care provider. The results of QFT-G are greater specificity and results are available 24 hours after the blood is collected. Question 2 1 / 1 pts Determine the ABG and the compensatory mechanism: ABG Value pH: 7.55 [HCO ]:31 mEq/L PaCO : 37 mmHg 3- 2 metabolic alkalosis, complete compensated respiratory alkalosis, complete compensated normal ABG respiratory acidosis, partial uncompensated metabolic acidosis, partial compensated metabolic alkalosis, partial uncompensated Question 3 1 / 1 ptsThese structures of the brain are responsible for the nervous control of breathing and regulates the basic rhythm and depth of respirations. coronary sinus and alveoli carotid artery and aorta brachiocephalic vein and superior vena cava medulla oblongata and pons Question 4 1 / 1 pts A client with a chronic airflow limitation is experiencing respiratory acidosis as a complication. The nurse who is trying to enhance the client’s respiratory status would avoid doing which of the following? Encouraging the client to breathe fast and shallowly Assisting the client to turn, cough, and deep breathe Keeping the head of the bed elevated Monitoring the flow rate of supplemental oxygenRationale: The client with respiratory acidosis is experiencing elevated carbon dioxide levels due to insufficient ventilation. The nurse would encourage the client to breathe slowly and deeply (not shallowly) to expand alveoli and to promote better gas exchange. The actions listed in options 1, 2, and 3 are helpful actions on the part of the nurse. Test-Taking Strategy: Note that the question contains the strategic word “avoid.” With this in mind, eliminate options that are beneficial to airway status, and choose the one that would cause further impairment. Review care of the client with respiratory acidosis if you had difficulty with this question. Question 5 1 / 1 pts A client is seen in the health care clinic and a diagnosis of acute sinusitis is made. The nurse reinforces home care instructions to the client regarding measures that will promote sinus drainage and comfort. Which statement by the client indicates a need for further education? "I should apply heat such as a wet pack over the sinuses." "I will need surgery asap to drain the sinuses." "I should try to sleep with the head of the bed elevated." "I should drink large amounts of fluids."Answer: B Rationale: The nurse provides instructions to the client regarding measures to promote sinus drainage, comfort, and resolution of the infection. The nurse instructs the client to apply heat in the form of hot wet packs over the affected sinuses to promote comfort and help resolve the infection. Large amounts of fluids are important to help liquefy secretions. Sleeping with the head of the bed elevated to a 45-degree angle will assist in promoting drainage. Surgery may be performed to improve drainage in chronic conditions if other measures are not helpful. Strategy: Note the key words indicates a need for further education and promote sinus drainage and comfort. Noting that the question addresses an acute condition and recalling that conservative measures are usually implemented before surgery will direct you to option 2. If you had difficulty with this question, review client teaching points related to acute sinusitis. Question 6 1 / 1 pts A client has been taking isoniazid (INH) for 1 ½ months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing: Small blood vessel spasm Hypercalcemia Impaired peripheral circulation Peripheral neuritis Rationale: A common side effect of isoniazid (INH) is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This side effect can be minimized with pyridoxine (vitamin B6) intake. Question 7 1 / 1 pts The nurse has reinforced instructions with a patient with pleural effusion about strategies to promote comfort during recuperation. The nurse evaluates that the patient has understood the instructions if the patient states that he or she will do which of the following? Lie as much as possible on the unaffected side Try to take only small, shallow breaths Splint the chest wall during coughing and deep breathing Take as much pain medication as possible Effective coughing out of secretions can be achieved by splinting the chest wall which also decreases pain and discomfortQuestion 8 1 / 1 pts A patient, age 22, is admitted with acute asthma. It is important to monitor his oxygen saturation levels. The quickest way to assess his saturation of oxygen is to get arterial blood gases. do a pulmonary function test. use pulse oximetry. do a pulse pressure assessment. In acute asthma, oxygen therapy should be started immediately, and its administration should be monitored by pulse oximetry. Pulse oximetry is noninvasive and provides continuous monitoring of SaO2. Question 9 1 / 1 pts A nurse assists in preparing a care plan for the client who will be returning from surgery following a right wedge resection. Included in the plan is that in the postoperative period the nurse should avoid positioning this client: On the left side On the right side In semi-Fowler's positionIn low-Fowler's Rationale: Following a wedge resection, the client should not be placed on the operative side. Lying on the operative side hinders expansion of remaining lung tissue and may accentuate perfusion of poorly ventilated tissue. This further impedes normal gas exchange. Question 10 1 / 1 pts A nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease (COPD). Which of the following would the nurse expect to note in this client? A shortened expiratory phase of respiration Hypocapnia Increased oxygen saturation with exercise Dyspnea on exertion and activity Rationale: Clinical manifestations of COPD include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, use of accessory muscles of respiration, and a prolonged expiratory phase of respiration. The chest x-ray will reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced.Question 11 1 / 1 pts A client is at risk of developing a pulmonary embolism. The nurse monitors for which of the following, which is the most commonly reported initial symptom? Hot, flushed feeling Sudden chills and fever Dyspnea noted when deep breaths are taken Chest pain that occurs suddenly with dyspnea Rationale: The most common initial symptom in pulmonary embolism is chest pain that is sudden in onset. The next most commonly reported symptom is dyspnea, which is accompanied by an increased respiratory rate. Other typical symptoms of pulmonary embolism include cough, tachycardia, fever, diaphoresis, anxiety, and possibly syncope. Question 12 1 / 1 pts A nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease (COPD). Which of the following would the nurse expect to note in evaluating this client? A hyperinflated chest on x-ray Increased oxygen saturation with exerciseHypocapnia A widened diaphragm noted on chest x-ray Rationale: Clinical manifestations of COPD include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-ray will reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced. Question 13 1 / 1 pts A client who has had a radical neck dissection related to laryngeal cancer begins to bleed at the incision site. Which action by the nurse would be contraindicated? Positioning patient on fowler’s position Lowering the head of the bed to a flat position Monitoring the client's airway Calling the physician immediatelyAnswer: A Rationale: If the client begins to hemorrhage from the surgical site following radical neck dissection, the nurse elevates the head of the bed to maintain airway patency and prevent aspiration. The nurse applies pressure over the bleeding site, and calls the physician immediately Strategy: Use the process of elimination and note the key word, contraindicated. This word indicates a false response question and that you need to select the incorrect action. Option 1 would not maintain airway patency. Review care of the client following radical neck dissection if you had difficulty with this question. Question 14 1 / 1 pts A client who has laryngeal nodules being evaluated for cancer of the larynx is scheduled for out-patient surgery to have them removed. The nurse collects data on the client and expects the client to complain of which typical symptom associated with this condition? Hoarseness Sore throat Swollen glands AphoniaRationale: Hoarseness is a typical symptom associated with laryngeal nodules. Aphonia is associated with laryngitis. Sore throat typically occurs with pharyngitis. Swollen glands usually accompany tonsillitis. Question 15 1 / 1 pts A nurse is assisting in caring for a client with an endotracheal tube attached to a ventilator when the high-pressure alarm sounds. The nurse checks the client and system for which most likely cause? Disconnection from the ventilator Loose connection in the system Obstruction that can be caused by accumulation of secretions in the client’s lungs Endotracheal tube cuff leakRationale: When the high-pressure alarm sounds on a ventilator, it is most likely due to an obstruction. The obstruction can be caused by the client biting on the tube, kinking of the tubing, or mucus in the lungs that requires suctioning. It is also important to assess the tubing for the presence of any water and determine if the client is out of rhythm with breathing with the ventilator. The incorrect options list items that may be responsible for a lowpressure alarm on the ventilator. Test-Taking Strategy: Note the strategic words “highpressure alarm” in the question. Recall that the highpressure alarm indicates a possible obstruction to help guide you to the correct option. Review the causes of the high-pressure alarm on a ventilator if you had difficulty with this question. Question 16 1 / 1 pts Zyloprim 250 mg PO everyday. Supply: scored tablets of 100 mg. What is the quantity to administer? 2.5 1.5 3.5 2 Question 17 1 / 1 ptsA nurse is caring for a client who had a Mantoux skin test 48 hours ago on admission to the nursing unit and reads the result of the skin test as positive. Which action by the nurse is the priority? Call the employee health service department. Call the radiology department for a chest x-ray. Report the findings. Document the finding in the client's record. Answer: a Rationale: The nurse who interprets a Mantoux test as positive notifies the physician immediately. The physician would order a chest x-ray to determine whether the client has clinically active tuberculosis (TB) or old, healed lesions. A sputum culture would be done to confirm the diagnosis of active TB. The client is placed on TB precautions prophylactically until a final diagnosis is made. The findings are documented in the client's record but this action is not the highest priority. Calling the employee health service would be of no benefit to the client. Strategy: Use the process of elimination and note the key word, priority. Because the nurse may not order diagnostic tests, eliminate option 2 first. Similarly, option 4 can be eliminated, because calling the employee health service is of no benefit to the client. From the remaining options, notifying the physician should have a higher priority than the documentation, even though they may both be done in the same narrow time period. Review nursing interventions related to Mantoux testing if you had difficulty with this question.Question 18 1 / 1 pts A client is to begin a 6-month course of therapy with isoniazid (INH). A nurse plans to teach the client to: Increase intake of Swiss or aged cheese Avoid vitamin supplements during therapy Report yellowing of the eyes or skin immediately Drink alcohol in small amounts only INH is hepatotoxic and therefore the client is taught to report signs and symptoms of hepatitis or liver dysfunction immediately. Question 19 1 / 1 pts Interpret the ABG with included compensatory mechanism ABG Value pH: 7.28 [HCO ]:28 mEq/L PaCO : 46 mmHg 3- 2 normal ABG metabolic acidosis, partial compensated metabolic alkalosis, partial uncompensatedrespiratory alkalosis, partial uncompensated respiratory acidosis, partial compensated Question 20 1 / 1 pts A nursing instructor is observing a nursing student suctioning a client through a tracheostomy tube. The nursing instructor intervenes if the student performed which incorrect action? Applying suction during withdrawal of the catheter Applying suction during insertion of the catheter Using sterile technique to perform the procedure Hyperventilating the client with 100% oxygen before suctioning Answer: c. Rationale: The client should be hyperoxygenated with 100% oxygen prior to suctioning. Sterile technique is always used. Suction is not applied during insertion of the catheter, and intermittent suction and a twirling motion of the catheter are used during withdrawal. Strategy: Use the process of elimination and note the key words, incorrect action. These words indicate a false response question and that you need to select the incorrect action. Visualize the procedure and think about the mechanical trauma that suctioning can cause to the tissues. This will direct you to option 3. Review this procedure if you had difficulty with this question.Question 21 1 / 1 pts A patient comes into the clinic complaining of a nonproductive cough and muscle aches that she has had for 5 days. She has no sore throat, temperature elevation, or swollen lymph nodes. She is coughing so much that she is unable to sleep at night. The physician might order which of the following? Antitussive Expectorant Antibiotic Decongestant Antitussives are used for the relief of overactive or nonproductive coughs. Question 22 1 / 1 pts The patient has been admitted for possible carcinoma of the larynx. The first sign or symptom that may be present in carcinoma of the larynx is often persistent hoarseness. pain in the larynx. hemoptysis. dysphagia.Progressive or persistent hoarseness is an early sign. Question 23 1 / 1 pts When caring for a client who has TB, the nurse is required to wear: surgical mask and gown N-95 mask Hazmat suit a gas mask Patients on airborne precaution needs to wear the N-95 tp prevent from inhaling the infectious agent. Question 24 1 / 1 pts The end structures of the bronchial tree are saclike structures that resemble a bunch of grapes wherein gas exchange takes place. Bronchioles PharynxTrachea Alveoli Question 25 1 / 1 pts This is a tube-like structure that extends to the mid-chest, where it divides into the right and left bronchi. It contains C-shaped cartilaginous rings that keep it from collapsing: Larynx Nares Pharynx Trachea Question 26 1 / 1 pts A nurse is listening to the client's breath sounds and hears musical whistling noises on inspiration and expiration scattered throughout the right lung fields. The nurse interprets that this client has: Pleural friction rub Rhonchi Wheezes CracklesAnswer: B Rationale: Wheezes are musical noises heard on inspiration, expiration, or both. They are the result of narrowed air passages. Crackles have the sound that is heard when a few strands of hair are rubbed together near the ear and indicate fluid in the alveoli. Rhonchi are usually heard on expiration when there is excessive production of mucus, which accumulates in the air passages. A pleural friction rub is characterized by sounds that are described as creaking, groaning, or grating in quality. The sounds are localized over an area of inflammation of the pleura and may be heard in both the inspiratory and expiratory phases of the respiratory cycle. Strategy: Focus on the data in the question. The words musical and whistling are the key words that will direct you to option 2. Review the characteristics of the various breath sounds if you had difficulty with this question. Question 27 1 / 1 pts A nurse is observing a nursing student listening to the breath sounds of a client. The nurse intervenes if the student performs which incorrect procedure? Uses the diaphragm of the stethoscope Asks the client to sit upright Asks the client to normally breatheThe student auscultates and places the stethoscope on the client’s gown Rationale: To listen to breath sounds, the stethoscope is always placed directly on the client’s skin, and not over a gown or clothing. The nurse asks the client to sit up and breathe slowly and deeply through the mouth. Breath sounds are auscultated using the diaphragm of the stethoscope, which is warmed prior to use. Test-Taking Strategy: Note the strategic words “incorrect procedure.” Thinking about this data collection procedure and noting the words “on the client’s gown” in option 3 will direct you to this option. Review the correct method for listening to breath sounds if you had difficulty with this question. Question 28 1 / 1 pts A nursing diagnosis for the patient with a new laryngectomy would be Social isolation related to impaired verbal communication related to removal of the larynx. What is an appropriate nursing intervention? Ignore and offer books or jigsaw puzzles for entertainment Refrain from conversations with the patient to reduce stress level Complete care quickly Provide a pad and pencil or magic slate to write onProvide patient with implements for communication. Rapidly completing care and provision of solitary activities does not reduce social isolation. Question 29 1 / 1 pts A nurse is assisting in caring for a client with a newly inserted tracheostomy. The nurse reviews the nursing care plan and notes documentation of a nursing diagnosis of Impaired Gas Exchange. The nurse should monitor for which item as the best indicator of an adequate respiratory status? Moderate amounts of tracheobronchial secretions Oxygen saturation of 89% Respiratory rate of 18 breaths per minute and regular Moderate amounts of frank blood suctioned from the tube Rationale: Impaired Gas Exchange could occur following tracheostomy from excessive secretions, bleeding into the trachea, restricted lung expansion caused by immobility, or concurrent respiratory conditions. An oxygen saturation of 89% is less than optimal. The respiratory rate of 18 breaths per minute is well within the normal range of 14 to 20 breaths per minute.Question 30 1 / 1 pts A nurse has just been given an order to administer albuterol (Proventil HFA) to a client. The nurse evaluates the effectiveness of the medication by noting which of the following before and during therapy? Urine output and blood urea nitrogen Nausea and vomiting Resolving dyspnea and clear lung sounds Headache and level of consciousness Rationale: Albuterol is an adrenergic bronchodilator. The nurse monitors respiratory pattern, lung sounds, pulse, and blood pressure prior to and during therapy. The color, character, and amount of sputum also are noted. The medication is not given to affect the parameters listed in any of the other options. Test-Taking Strategy: Focus on the name of the medication. Recalling that this medication is a bronchodilator will direct you to option 1. Review nursing considerations for administering this medication if you had difficulty with this question. Question 31 1 / 1 pts Identify the ABG including the compensatory mechanism ABG ValuepH: 7.48 [HCO ]:23 mEq/L PaCO : 31 mmHg 3- 2 respiratory acidosis, partial compensated metabolic alkalosis, partial compensated normal ABG metabolic acidosis, partial uncompensated respiratory alkalosis, partial uncompensated Question 32 1 / 1 pts An 83-year-old patient is admitted with a temperature of 102° F (38.8° C), chest pain, and fatigue. The chest radiograph reveals an accumulation of fluid in the pleural space, which the physician removes by performing a thoracentesis. The nurse correctly records the purulent exudate pus as: sputum. emphysema. effusion. empyema. If the fluid between the lung and the membrane lining the pleural cavity becomes infected, it is called empyema.Question 33 1 / 1 pts A nurse is caring for a client following pulmonary angiography via catheter insertion into the left groin. The nurse monitors for an allergic reaction to the contrast medium by noting the presence of: Discomfort in the left groin Hematoma in the left groin Hypothermia Respiratory distress Rationale: Signs of allergic reaction to the contrast medium include localized itching and edema, respiratory distress, stridor, and decreased blood pressure. Hypothermia is an unrelated event. Discomfort is expected. Hematoma formation is a complication of the procedure, but does not indicate an allergic reaction. Question 34 1 / 1 pts A 55-year-old man comes to the health nurse at his place of work with epistaxis. He reports he has frequent nosebleeds that he can usually control himself. What would be the most helpful assessment after the nurse has stopped the bleeding? Record the approximate amount of blood lost Record the last episode of epistaxisInquire about a diarrhea Obtain or check the blood pressure Check the blood pressure for hypotension to assess for hypovolemic shock. Adults can lose as much as 1 L of blood in an hour with heavy epistaxis. Question 35 1 / 1 pts A clinic nurse is providing instructions to a client with a diagnosis of pharyngitis. The nurse instructs the client to: Drink only warm tea throughout the day. Drink warm hot chocolate in place of coffee. Avoid foods that are citrus, spicy and highly seasoned. Restrict fluid intake to 1000 mL daily.Rationale: The client with pharyngitis should be instructed to consume cool clear fluids, ice chips, or ice pops to soothe the painful throat. Citrus products should be avoided because they irritate the throat. Milk and milk products are avoided because they tend to increase mucus production. Foods that are highly seasoned are irritating to the throat and should be avoided, and the client should be instructed to drink 2000 to 3000 mL of fluid daily unless contraindicated. Question 36 1 / 1 pts A nurse is gathering data on a client with a diagnosis of tuberculosis (TB). The nurse reviews the results of which diagnostic test that will confirm this diagnosis? Chest x-ray Sputum Culture Bronchoscopy PPD skin testAnswer: c Rationale: A definitive diagnosis of TB is confirmed through culture and isolation of Mycobacterium tuberculosis. A presumptive diagnosis is made on the basis of a tuberculin skin test, a sputum smear that is positive for acid-fast bacteria, a chest x-ray, and histologic evidence of granulomatous disease on biopsy. Strategy: Use the process of elimination and note the key word, confirm, in the stem of the question. Confirmation is made by identifying Mycobacterium tuberculosis. If you had difficulty with this question, review the diagnostic procedures related to TB. Question 37 1 / 1 pts The physician ordered 1000 mL of D5W to infuse over 16 hours with a drop factor of 20 gtt/mL. Calculate the correct IV flow rate in drops per minute. Round off to the nearest whole number. 21 28 32 46 Question 38 1 / 1 pts A nurse has instructed a client diagnosed with tuberculosis (TB) about how to prevent the spread of infection after discharge. Thenurse determines that the client needs further reinforcement of information if the client makes which of the following statements? "It's very important to wash my hands after I touch my mask, tissues, or body fluids." "It's important to cover my mouth if I laugh, sneeze, or cough." "I should cough into tissues and throw them away carefully." "I should have food placed on disposable plates, forks, and knives."' Answer: D Rationale: Because tuberculosis is transmitted by droplets, it cannot be carried on clothing, eating utensils, or other possessions. It is important to perform proper hand washing after contact with body substances, tissues, or facemasks. The client should cover the mouth with a tissue when laughing, coughing, or sneezing, and dispose of tissues the carefully. Strategy: Note the key words, needs further reinforcement of information. These words indicate a false response question and that you need to select the incorrect client statement. Recall that TB is an airborne disease and that organisms cannot be carried on inanimate objects. This will direct you to option 4. Review client teaching points related to the prevention of the spread of TB if you had difficulty with this question.Question 39 1 / 1 pts The appropriate nursing intervention for a patient, age 40, who is diagnosed with active tuberculosis would be to place the patient in acid-fast bacillus (AFB) isolation or airborne precautions. place the patient in drainage and secretion precautions. place the patient in any isolation precautions. maintain the patient in enteric isolation. If TB is suspected, permission to place the patient in acidfast bacilli (AFB) isolation precautions should be requested immediately. Question 40 1 / 1 pts A patient is prescribed an inhalational corticosteroid therapy along with bronchodilator therapy. Which of the following points should the nurse include in the patient teaching plan? Take the corticosteroid several minutes after the bronchodilator dose. Before each dose of corticosteroid, rinse the mouth thoroughly with water.The corticosteroid drug provides rapid relief during an asthma attack. Stop corticosteroid therapy immediately if you notice any adverse effects. Question 41 1 / 1 pts Which of these terms describes an asthma attack that persists and does not respond to treatment? Intrinsic asthma Status asthmaticus Persistent asthma Asthma crisis Question 42 1 / 1 pts Identify the ABG including the compensatory mechanism ABG Value pH: 7.35 [HCO ]:22 mEq/L PaCO : 45 mmHg 3- 2 respiratory alkalosis, complete compensation normal ABG respiratory acidosis, complete compensation metabolic alkalosis, complete compensation metabolic acidosis, complete compensation Question 43 1 / 1 pts When a patient has experienced a pneumothorax, chest auscultation reveals: respiratory rate less than 16 breaths per minute. deep slowed respirations with equal chest movement. bilateral unequal breath sounds, with no breath sounds over the affected area. equal breath sounds over the affected area. Findings on auscultation are bilaterally unequal breath sounds, with no breath sounds over the affected area. A larger pneumothorax causes respiratory distress, including rapid shallow respirations, air hunger, dyspnea, and oxygen desaturation. Question 44 1 / 1 ptsA nurse is preparing a client for the administration of a Mantoux test. The nurse determines that which body area is the most appropriate area for injection of the medication? Dorsal aspect of the upper arm near a mole Inner aspect of forearm that is not heavily pigmented Dorsal aspect of the upper arm that has a small amount of hair Inner aspect of forearm that is close to a burn scar Answer: A Rationale: Intradermal injections are most commonly given in the inner aspect of the forearm. Other sites include the dorsal area of the upper arm or the upper back beneath the scapulae. The nurse finds an area that is not heavily pigmented and is removed from hairy areas or lesions, which could interfere with reading the results. Strategy: Using general principles regarding the administration of medications will direct you to option 1. Review these general principles and the procedure for administering intradermal injections if you had difficulty with this question. Question 45 1 / 1 pts A nursing student prepares to instruct a client to expectorate a sample of sputum that will be sent to the laboratory for Gramstain, culture, and sensitivity and describes the procedure to the licensed practical nurse (LPN), who is the primary nurse. The LPN corrects the student if which incorrect description is provided? “I will use a sterile container from the supply area.” “I will ask the client to brush the teeth and rinse the mouth before expectorating.” “I will send the specimen immediately to the laboratory.” “I will have the client take a breath and gather his saliva before shallow coughing.” Rationale: Because of the nature of the test, the sputum must be collected in a sterile (not a clean) container. The client should brush the teeth and rinse the mouth to decrease the number of contaminating organisms. The client should take a few deep breaths, and then cough forcefully (not spit) into the container. The specimen should be sent directly to the laboratory. It should not be allowed to stand for long periods at room temperature to prevent overgrowth of contaminating organisms. Test-Taking Strategy: Note the strategic words “incorrect description.” These words indicate a negative event query and ask you to select the incorrect procedure for collecting the sputum sample. Noting the words “shallow breath” in option 4 will direct you to this option. Review the procedure for collecting a sputum sample if you had difficulty with this question. Question 46 1 / 1 ptsA nurse is caring for the client who is at risk for lung cancer due to an extremely long history of heavy cigarette smoking. The nurse tells the client to report which most frequent early symptom of lung cancer? Hoarseness Hemoptysis Nonproductive dry hacking cough Pleuritic pain Rationale: Cough is the most frequent early symptom of lung cancer, which begins as nonproductive and hacking, and progresses to productive. In the smoker who already has a cough, a change in the character and frequency of the cough usually occurs. Hoarseness and blood-streaked sputum are later signs. Pain is a very late sign and is usually pleuritic in nature. Test-Taking Strategy: Focus on the strategic words “most frequent early symptom.” This will assist in eliminating options 2 and 3, which obviously are later signs. To select between cough and hoarseness, remember that hoarseness would indicate a problem with the larynx, whereas cough would indicate a lower airway problem. Review the common early signs of lung cancer if you had difficulty with this question. Question 47 1 / 1 pts A patient, age 69, has emphysema. On assessing him, the nurse notes the presence of a “barrel chest.” This pathology resultsfrom a(n) increased anteroposterior diameter caused by overinflation of the alveoli. increase in the lateromedial area from hypertrophy of mucous glands in the bronchi. widening of the sternocostal area decrease in anteroposterior diameter caused by chronic dilation of the bronchi. The patient will eventually appear barrel chested (an increased anteroposterior diameter caused by overinflation). Question 48 1 / 1 pts A postoperative client with incisional pain complains to the nurse about completing respiratory exercises. The client is willing to do the deep breathing exercises but states that it hurts to cough. The nurse provides gentle encouragement and appropriate pain management to the client, knowing that coughing is needed to: Provide for decreased oxygen tension in the alveoli. Expel and clear mucus from the airways. Exercise the muscles of respiration. Dilate the terminal bronchioles.Rationale: Coughing is one of the protective reflexes. Its purpose is to move mucus that is in the airways upward toward the mouth and nose. Coughing is needed in the postoperative client to mobilize secretions and expel them from the airways. The other options do not accurately address the purpose of coughing in the postoperative client. Test-Taking Strategy: Focus on the subject, the purpose of coughing in a postoperative client. Recalling the effects of anesthesia on the respiratory system and the respiratory complications that can occur will direct you to option 1. Review the purposes of coughing if you had difficulty with this question. Question 49 1 / 1 pts Identify the ABG including the compensatory mechanism ABG Value pH: 7.27 [HCO ]:24 mEq/L PaCO : 53 mmHg 3- 2 respiratory acidosis, partial uncompensated metabolic acidosis, complete compensated metabolic alkalosis partial uncompensated normal ABGQuestion 50 1 / 1 pts Treatment for active tuberculosis includes which of the following? Chemotherapy in patients at high risk for developing infection The need to develop drug-resistant organisms Long-term treatment with at least 4 drug combination for about 6-9 months Chemoprophylaxis with bacteriostatic medications Antitubercular drugs are classified as primary or secondary agents to describe the way they are used in treating tuberculosis. The combination of drugs helps to slow the development of bacterial resistance. Question 51 1 / 1 pts Which patient assessment indicates the most severe respiratory distress? Substernal retraction, SaO2 90% Abdominal breathing, SaO2 97% Symmetrical chest wall expansion, SaO2 88% Substernal retraction, SaO2 84%Observe the patient’s facial expressions and signs of respiratory distress, such as flaring nostrils, substernal or clavicular retractions, asymmetrical chest wall expansion, and abdominal breathing. The lower the SaO , the more severe the respiratory distress. 2 Question 52 1 / 1 pts The physician ordered 100 mg of Cleocin (clindamycin) IM q6h. The drug is available in a vial labeled 300 mg/2 mL. Using a 1-mL syringe and rounding off to the nearest tenth, how many milliliters of Cleocin would the nurse give for each dose? Use the formula method to calculate the dosage. 0.6 0.5 0.4 0.7 Question 53 1 / 1 pts A young mother tells the nurse that her 6-month-old baby has a cough and that she is giving the baby an OTC cough and decongestant preparation. Which of the following statements would the nurse teach this young mother? These products are safe if given diluted.Over-the-counter medication is safe for infants. These products are safe in infants over 6 months. These products are not safe for infants. In 2007, the FDA announced that over-the-counter cold products should not be used in infants because they are unsafe. Question 54 1 / 1 pts Which nursing intervention does the nurse add to the care plan to help a patient with thick sputum mobilize and expectorate those secretions? Inhale cool mist from a vaporizer for 24 hours. Sit in a tub of hot water three times a day. Drink salty fluids such as broth and bouillon. Encourage drinking about 3 to 4 L of water a day. Encourage fluids to liquefy secretions and aid in their expectoration. Question 55 1 / 1 ptsWhat does a nurse teach an adult male who has had a tonsillectomy? Eat solid foods during the first 24 hours. Avoid coughing vigorously and clearing the throat during the first week postoperatively. Do not eat or drink anything for the first 48 hours. Apply a heating pad to the neck during the first 24 hours. The nurse should teach the patient to avoid attempting to clear the throat immediately after surgery and to avoid coughing, sneezing, or vigorous nose blowing for 1 to 2 weeks. Maintain IV fluids until the nausea subsides, at which time the patient may begin drinking ice-cold clear liquids. The diet is advanced to custard and ice cream and then to a normal diet as soon as possible. Apply an ice collar to the neck for comfort and to reduce bleeding by vasoconstriction. Question 56 1 / 1 pts A patient, age 54, is on postoperative day 2 after undergoing an open cholecystectomy. Immediately after the surgery, she vomited and may have aspirated some emesis. The nurse is concerned that the patient will develop pneumonia. In planning for her care, the nurse suspects the patient may have viral cal pneumonia. bacterial pneumonia. aspiration pneumonia. Aspiration pneumonia occurs most commonly as a result of aspiration of vomitus when the patient is in an altered state of consciousness due to a seizure, drugs, alcohol, anesthesia, acute infection, or shock. Question 57 1 / 1 pts A nurse is suctioning a client through a tracheostomy tube. The nurse plans to apply suction during the withdrawal of the catheter for a period of time no greater than: 10 seconds 35 seconds 30 seconds 25 secondsAnswer: 10 seconds Rationale: During suctioning, the nurse would apply suction during the withdrawal of the catheter for a period of 5 to 10 seconds. Suction applied longer than this can cause hypoxia in the client. Strategy: Visualize this procedure and recall the complications associated with suctioning. Note the key words, no greater than. It is best to select the option that identifies the least amount of time. Review the procedure for suctioning if you had difficulty with this question. Question 58 1 / 1 pts Which of the following diets would be prescribed to the patient who just had bronchoscopy? Clear liquid for now NPO until gag refllex returns Diet as tolerated Bland, avoiding temperature extremes such as coffee or ice cream Patient after bronchoscopy should be kept on NPO until return of gag reflex and bowel sounds. Clear and soft diet first and if tolerated may resume to previoius diet as not to vause aspiration to the irrited throat.Question 59 1 / 1 pts ABG Value pH: 7.40 [HCO ]:25 mEq/L PaCO : 35 mmHg 3- 2 metabolic acidosis, complete compensated respiratory alkalosis, partial uncompensated respiratory acidosis, complete compensated metabolic alkalosis, partial uncompensated normal ABG Question 60 1 / 1 pts A client has been started on long-term therapy with rifampin (Rifadin). A nurse teaches the client that the medication: Should be double-dosed if one dose is skipped May be discontinued independently if symptoms are gone in 3 months Causes red-orange discoloration of sweat, tears, urine, and feces Should always be taken with food or antacidsRifampin causes orange-red discoloration of body secretions and will permanently stain soft contact lenses Question 61 1 / 1 pts The substance that reduces the surface tension of alveolus and prevents it from collapsing after each breath is called_______________. surfactant turbinates chemoreceptors pleural fluid Question 62 1 / 1 pts A female client is scheduled to have a chest x-ray. Which question is most important to ask the client during data collection? "Can you hold your breath easily?" "Are you wearing any metal chains or jewelry?" "Are you able to hold your arms above your head?" "Is there any possibility that you could be pregnant?"Answer: a Rationale: The most important question to ask is about the client's pregnancy status, because pregnant women should not be exposed to radiation. Clients are also asked to remove any chains or metal objects that could interfere with obtaining an adequate film. A chest x-ray is most often done at full inspiration, which gives optimal lung expansion. If a lateral view of the chest is ordered, the client is asked to raise the arms above the head. Most films are taken Strategy: Note the key words, most important. Recalling the teratogenic effects of radiation on the fetus will direct you to option 1. Review this procedure if you had difficulty with this question in the posterioranterior (PA) view Question 63 1 / 1 pts Identify the ABG including the compensatory mechanism ABG Value pH: 7.48 [HCO ]:25 mEq/L PaCO : 33 mmHg 3- 2 respiratory acidosis, partial compensated metabolic alkalosis, partial uncompensated metabolic acidosis, complete compensated respiratory alkalosis, partial uncompensated normal ABGQuestion 64 0 / 1 pts An emergency room nurse is caring for a client who sustained a blunt injury to the chest wall. Which sign if noted in the client would indicate the presence of a pneumothorax? Bradypnea A low respiratory rate u Answered u Answered The presence of a barrel chest rrect Answer rrect Answer Shortness of breath Rationale: This client has sustained a blunt or a closed chest injury. Basic symptoms of a closed pneumothorax are shortness of breath and chest pain. A larger pneumothorax may present with tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema. There may also be hyperresonance on the affected side. Question 65 1 / 1 pts A client taking theophylline (Theo-24) has a serum theophylline level of 15 mcg/mL. The nurse interprets that this result is: Within the therapeutic range. Below the therapeutic range.In excess of the therapeutic range. Near the top of the therapeutic range. Rationale: The normal therapeutic range for theophylline levels is 10 to 20 mcg/mL. A level greater than 20 mcg/mL is considered toxic. The value of 15 mcg/mL places the client in the middle of the therapeutic range. Test-Taking Strategy: Specific knowledge regarding the therapeutic drug level for this medication is needed to answer this question. Recalling that the normal therapeutic range is 10 to 20 mcg/mL will direct you to option 2. Review the therapeutic range for theophylline if you had difficulty with this question. Question 66 1 / 1 pts The leaf-shaped cartilage that covers the larynx during swallowing is the ______________. larynx epiglottis adam’s apple trachea Question 67 1 / 1 ptsA nurse has taught a client about the use of a respiratory inhaler. Which statement by the client indicates a need for further teaching? "I need to press the canister down with my finger as I breathe in." "I need to inhale quickly the mist and also quickly exhale." "I need to remove the cap and shake the inhaler well before use." "I need to wait between puffs if more than one puff has been prescribed.” Rationale: The client should be instructed to hold his or her breath for at least 5 to 10 seconds before exhaling the mist. Question 68 1 / 1 pts A nurse is reading the results of a Mantoux skin test on a client with no documented health problems. The site has no induration and a 1-mm area of ecchymosis. The nurse interprets this as: Borderline NegativePositive Needs to repeat the test Question 69 0 / 1 pts A nurse is caring for a client who witness a bombing incident is nervous and hyperventilating. The nurse would monitor the client for signs of which of the following acid-base imbalances? Metabolic acidosis u Answered u Answered Respiratory acidosis Metabolic alkalosis rrect Answer rrect Answer Respiratory alkalosis Rationale: A client who hyperventilates blows off excessive carbon dioxide. This would have the effect of inducing alkalosis. Because a respiratory problem is triggering the alteration, it is called a respiratory alkalosis. Test-Taking Strategy: Note the strategic word “hyperventilating” in the question. This tells you that the correct option is more likely to be respiratory in origin. Recalling that blowing off carbon dioxide triggers alkalosis will help you choose correctly from the remaining two options. Review the basics of acid-base imbalance if you had difficulty with this question.Question 70 1 / 1 pts A tuberculin test (Mantoux test) is administered to an individual infected with human immunodeficiency virus (HIV). Seventy-two hours later, the nurse evaluates the test site and documents the results as positive, indicating that the individual has been exposed to tuberculosis. Which of the following findings did the nurse note to make this interpretation? An area of induration at the test site measuring 7 mm An area of induration at the test site measuring 2 mm Redness and swelling at the test site without induration Redness and swelling at the test site with an induration measuring 3 mm Answer: B Rationale: Normally, an area of induration greater than 15 mm is considered positive in low-risk individuals. However, an area of induration that measures 5 mm or greater in people with HIV infection is considered positive. Redness and swelling do not indicate a positive test result. Strategy: Focus on the issue—that the client has HIV. Recall that in a person infected with HIV, an area of induration 5 mm or greater is considered positive. If you had difficulty with this question, review the Mantoux test and interpretation of the test results. Question 71 1 / 1 ptsA 62-year-old patient is seen in the emergency department with an epistaxis. When a patient has an epistaxis, the correct nursing interventions would be compress the nostrils tightly below the bone and hold for 1 minute. place the patient in Fowler’s position with the head leaning forward. place hot compresses over the nose. place the patient in low-Fowler’s position with the head hyperextended. Elevate head of bed. Place patient in Fowler’s position with the head forward. Compression of nostrils should be for 10-15 minutes. Hot compresses will increase bleedingice should be applied. Question 72 1 / 1 pts ORDER: Tetracycline syrup 0.5 g PO Q6h. SUPPLY: liquid labeled 250 mg per 10 ml. What is the quantity to be administered? 10 ml 20 ml 15 ml30 ml Question 73 1 / 1 pts A patient with allergic rhinitis is prescribed an antihistamine. To prevent which of the following conditions should the nurse instruct the patient to suck on a sugarless hard candy? Thickening of the bronchial secretion Dryness of the oral mucosa and the throat Altered sensation of taste Drowsiness and sedation Question 74 1 / 1 pts A nurse in an ambulatory clinic is preparing to administer a Mantoux skin test to a client who may have been exposed to an individual with tuberculosis (TB). The client reports having had the Bacille Calmette Guerin (BCG) vaccine before moving to the United States from a foreign country. The nurse interprets that: The client has no risk of acquiring TB and needs no further workup. The client's Mantoux test will be negative and will require sputum culture to diagnose.The client is at more risk of acquiring TB and needs immediate medication therapy. The client's Mantoux test will be positive and will require chest x-ray for evaluation. Rationale: The Bacille Calmette-Guerin vaccine is routinely given in many foreign countries to enhance resistance to TB. The vaccine uses attenuated tubercle bacilli, so the client will always test positive on Mantoux skin testing after receiving the vaccine. This client needs to be evaluated for TB with a chest x-ray. Question 75 1 / 1 pts Which interventions are health promotions to prevent pneumonia? (Select all that apply.) Position patient flat on their back to prevent aspiration. Provide for good health habits (nutrition, hygiene, exercise). Encourage elder patients to receive influenza and pneumococcal vaccines. Allow new stroke patients to feed themselves to encourage self-care.Check for placement before administering tube feedings. Older adults should receive pneumococcal and influenza vaccines. Good health habits are the basis for preventing disease. Aspiration can occur if the nasogastric tube is not correctly placed in the stomach. New stroke patients should be assisted with eating until the gag reflex is established. Question 76 1 / 1 pts Which independent nursing measures are effective in helping ease a patient to expectorate thick secretions? (Select all that apply) Assisting to deep breathe first before coughing Suctioning Providing hydration Positioning in sitting position Starting and pushing IV fluidsIndependent nursing intervention to help a patient to expectorate would include positioning, assisting to cough, suctioning, and providing hydration IV therapy; provision of a mucolytic agent requires a physician’s order and is not an independent nursing action.. Question 77 1 / 1 pts Which of the following are considered primary drugs (first-line) to treat tuberculosis? (Select all that apply): Rifampin (Rifadin) Ciprofloxacin (Cipro) Levofloxacin (Levaquin) Isoniazid (Nydrazid) Ethambutol (Myambutol) These drugs are the first line of medications for TB Question 78 1 / 1 pts When a patient states, "I can't walk very well," the first problemsolving step would be to:Find out what the problem is, such as weakness or poor balance. Choose the alternative with the best chance of success. Consider alternatives such as a wheelchair or walker. Consider the outcomes of the choices, such as danger of falling with a walker. Question 79 1 / 1 pts What is the movement of an extremity away from the midline of the body? Extension Adduction Flexion Abduction Question 80 1 / 1 pts The first priority nursing intervention for an impending fat embolism is to administer: Intravenous fluids Oxygen Blood therapy furosemide Quiz Score: 78 out of 80