DeWitt Medical -Surgical Nursing - Chapter 12, questions and answers with verified content

DeWitt Medical -Surgical Nursing - Chapter 12, questions and answers with verified content A 59 year old male patient with hypertension and COPD states he is having trouble breathing. He appears to be in distress and has labored breathing. Put in order of priority the nursing actions to be taken. 1) Raise the head of the bed. 2) Auscultate lung sounds 3) Take vital signs , including pulse oximetry reading 4) Report condition to provider 1) Raise the head of the bed. 2) Auscultate lung sounds 3) Take vital signs , including pulse oximetry reading 4) Report condition to provider A nurse is caring for several patients who are scheduled for diagnostic testing for respiratory disorders. The patient who needs post-procedural care includes frequent vital signs is the patient who had which of the following? 1) Capnography 2) A D- dimer test 3) A ventilation and perfusion scan 4) Bronchoscopy 4) Bronchoscopy A nurse is caring for a patient who is short of breath. The degree of shortness of breath can be assessed by which of the following? 1) Ability to speak 2) Breath sounds 3) Capnography 4) Nail-bed color 1) Ability to speak A nurse is caring for a patient who has asthma . Which lung sound would the nurse expect to hear when auscultating this patient's lung fields? 1)Fine crackles 2) Stridor 3) Pleural friction rub 4) Wheezes 4) Wheezes A nurse should observe for and report which abnormal breathing pattern that is most likely to occur in patients with increased intracranial pressure? 1) Cheyne-Stokes respirations 2) Kussmaul's respirations 3) Biot's respirations 4) Apneustic respirations 3) Biot's respirations A nurse attends to the nutritional needs of a patient with chronic respiratory disease by providing oral care. What is the best rationale for this nursing action ? 1) Low energy states diminish appetite 2) Respiratory secretions leave a bad taste 3) Chewing is believed to induce coughing spells 4) Nasal congestion reduces the flavor of food 2) Respiratory secretions leave a bad taste A nurse is caring for a patient who has had a thoracentesis with the removal of 800 cc of fluid. What finding would the nurse expect in the physical assessment of the patient post-procedure? 1) Slow heart rate 2) Clear lung sounds 3) Increased BP 4) Improved ventilation 2) Clear lung sounds While obtaining sputum for culture and sensitivity , the nurse notes that the specimen is thick, tenacious, and "ropey" This finding is most likely to be present in which disorder? 1) Pneumococcal pneumonia 2) Pulmonary edema 3) Chronic bronchitis 4) Tuberculosis 3) Chronic bronchitis 9) On initial assessment of a patient diagnosed with an acute exacerbation of COPD, the nurse is likely to find which signs and symptoms? ( select all that apply ) 1) Tensing of the shoulder muscles 2) Inability to tolerate sitting up 3) Flaring of the nostrils 4) Ability to complete sentences with no effort 5) Sternal retractions 1) Tensing of the shoulder muscles 3) Flaring of the nostrils 5) Sternal retractions A 72 year old patient has just returned to the nursing unit after a lung biopsy. The nurse watches closely for signs of which condition? 1) Hypotension 2) Hypercapnia 3) Hyperventilation 4) Hypovolemia 2) Hypercapnia