Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders
The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse, "How long will I have to be on these medications?" What should the nurse tell the patient?
3 months
3 to 5 months
6 to 12 months
13 to 18 months - correct answer 6 to 12 months
Explanation:
Pulmonary tuberculosis (TB) is treated primarily with anti-TB agents for 6 to 12 months. A prolonged treatment duration is necessary to ensure eradication of the organisms and to prevent relapse.
Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Pulmonary Tuberculosis, p. 549.
The nurse is assessing a client who, after an extensive surgical procedure, is at risk for developing acute respiratory distress syndrome (ARDS). The nurse assesses for which most common early sign of ARDS?
Rapid onset of severe dyspnea
Inspiratory crackles
Bilateral wheezing
Cyanosis - correct answer Rapid onset of severe dyspnea Explanation:
The acute phase of ARDS is marked by a rapid onset of severe dyspnea that usually occurs less than 72 hours after the precipitating event.
Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Acute Respiratory Distress Syndrome, p. 571.
The nurse is admitting a patient with COPD. The decrease of what substance in the blood gas analysis would indicate to the nurse that the patient is experiencing hypoxemia?
PaO2
pH
PCO2
HCO3 - correct answer PaO2 Explanation:
Hypoxemic hypoxia, or hypoxemia, is a decreased oxygen level in the blood (PaO2) resulting in decreased
oxygen diffusion into the tissues.
Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, ACUTE RESPIRATORY FAILURE, p. 556.
You are caring for a client with chronic respiratory failure. What are the signs and symptoms of chronic respiratory failure?
Progressive loss of lung function associated with chronic disease
Sudden loss of lung function associated with chronic disease
Progressive loss of lung function with history of normal lung function
Sudden loss of lung function with history of normal lung function - correct answer Progressive loss of lung function associated with chronic disease Explanation:
In chronic respiratory failure, the loss of lung function is progressive, usually irreversible, and associated with chronic lung disease or other disease. This makes options B, C, and D incorrect.
Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, OCCUPATIONAL LUNG DISEASE: PNEUMOCONIOSES, Veterans Considerations, p. 577. A nurse recognizes that a client with tuberculosis needs further teaching when the client states:
"I'll have to take these medications for 9 to 12 months."
"It won't be necessary for the people I work with to take medication."
"I'll need to have scheduled laboratory tests while I'm on the medication."
"The people I have contact with at work should be checked regularly." - correct answer "The people I have contact with at work should be checked regularly." Explanation:
The client requires additional teaching if he states that coworkers need to be checked regularly. Such casual contacts needn't be tested for tuberculosis. However, a person in close contact with a person who's infectious is at risk and should be checked. The client demonstrates effective teaching if he states that he'll take his medications for 9 to 12 months, that coworkers don't need medication, and that he requires laboratory tests while on medication. Coworkers not needing medications, taking the medication for 9 to 12 months, and having scheduled laboratory tests are all appropriate statements.
Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Pulmonary Tuberculosis, p. 551.
Which vitamin is usually administered with isoniazid (INH) to prevent INH-associated peripheral neuropathy?
Vitamin B6
Vitamin C
Vitamin D
Vitamin E - correct answer Vitamin B6 Explanation:
Vitamin B6 (pyridoxine) is usually administered with INH to prevent INH-associated peripheral neuropathy. Vitamins C, D, and E are not appropriate.
Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Pulmonary Tuberculosis, pp. 546-550. A nurse is preparing dietary recommendations for a client with a lung abscess. Which statement would be included in the plan of care?
"You must consume a diet rich in protein, such as chicken, fish, and beans."
"You must consume a diet low in calories, such as skim milk, fresh fruits, and vegetables."
"You must consume a diet high in carbohydrates, such as bread, potatoes, and pasta."
"You must consume a diet low in fat by limiting dairy products and concentrated sweets." - correct answer "You must consume a diet rich in protein, such as chicken, fish, and beans." Explanation:
The nurse encourages a client with a lung abscess to eat a diet that is high in protein and calories in order to ensure proper nutritional intake. A carbohydrate-dense diet or diets with limited fats are not advisable for a client with a lung abscess.
Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Lung Abscess, pp. 551-552.
The most diagnostic clinical symptom of pleurisy is:
Dullness or flatness on percussion over areas of collected fluid.
Dyspnea and coughing.
Fever and chills.
Stabbing pain during respiratory movements. - correct answer Stabbing pain during respiratory movements. Explanation:
The key characteristic of pleuritic pain is its relationship to respiratory movement: taking a deep breath, coughing, or sneezing worsens the pain. Pleuritic pain is limited in distribution rather than diffuse; it usually occurs only on one side. The pain may become minimal or absent when the breath is held; leading to rapid shallow breathing. It may be localized or radiate to the shoulder or abdomen. Later, as pleural fluid accumulates, the pain decreases.
Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, PLEURAL DISORDERS, Pleurisy, p. 553.
The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse, "How long will I have to be on these medications?" What should the nurse tell the patient?
3 months
3 to 5 months
6 to 12 months
13 to 18 months - correct answer 6 to 12 months
Explanation:
Pulmonary tuberculosis (TB) is treated primarily with anti-TB agents for 6 to 12 months. A prolonged treatment duration is necessary to ensure eradication of the organisms and to prevent relapse.
Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Pulmonary Tuberculosis, p. 549.
The nurse is assessing a client who, after an extensive surgical procedure, is at risk for developing acute respiratory distress syndrome (ARDS). The nurse assesses for which most common early sign of ARDS?
Rapid onset of severe dyspnea
Inspiratory crackles
Bilateral wheezing
Cyanosis - correct answer Rapid onset of severe dyspnea Explanation:
The acute phase of ARDS is marked by a rapid onset of severe dyspnea that usually occurs less than 72 hours after the precipitating event.
Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Acute Respiratory Distress Syndrome, p. 571.
The nurse is admitting a patient with COPD. The decrease of what substance in the blood gas analysis would indicate to the nurse that the patient is experiencing hypoxemia?
PaO2
pH
PCO2
HCO3 - correct answer PaO2 Explanation:
Hypoxemic hypoxia, or hypoxemia, is a decreased oxygen level in the blood (PaO2) resulting in decreased
oxygen diffusion into the tissues.
Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, ACUTE RESPIRATORY FAILURE, p. 556.
You are caring for a client with chronic respiratory failure. What are the signs and symptoms of chronic respiratory failure?
Progressive loss of lung function associated with chronic disease
Sudden loss of lung function associated with chronic disease
Progressive loss of lung function with history of normal lung function
Sudden loss of lung function with history of normal lung function - correct answer Progressive loss of lung function associated with chronic disease Explanation:
In chronic respiratory failure, the loss of lung function is progressive, usually irreversible, and associated with chronic lung disease or other disease. This makes options B, C, and D incorrect.
Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, OCCUPATIONAL LUNG DISEASE: PNEUMOCONIOSES, Veterans Considerations, p. 577. A nurse recognizes that a client with tuberculosis needs further teaching when the client states:
"I'll have to take these medications for 9 to 12 months."
"It won't be necessary for the people I work with to take medication."
"I'll need to have scheduled laboratory tests while I'm on the medication."
"The people I have contact with at work should be checked regularly." - correct answer "The people I have contact with at work should be checked regularly." Explanation:
The client requires additional teaching if he states that coworkers need to be checked regularly. Such casual contacts needn't be tested for tuberculosis. However, a person in close contact with a person who's infectious is at risk and should be checked. The client demonstrates effective teaching if he states that he'll take his medications for 9 to 12 months, that coworkers don't need medication, and that he requires laboratory tests while on medication. Coworkers not needing medications, taking the medication for 9 to 12 months, and having scheduled laboratory tests are all appropriate statements.
Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Pulmonary Tuberculosis, p. 551.
Which vitamin is usually administered with isoniazid (INH) to prevent INH-associated peripheral neuropathy?
Vitamin B6
Vitamin C
Vitamin D
Vitamin E - correct answer Vitamin B6 Explanation:
Vitamin B6 (pyridoxine) is usually administered with INH to prevent INH-associated peripheral neuropathy. Vitamins C, D, and E are not appropriate.
Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Pulmonary Tuberculosis, pp. 546-550. A nurse is preparing dietary recommendations for a client with a lung abscess. Which statement would be included in the plan of care?
"You must consume a diet rich in protein, such as chicken, fish, and beans."
"You must consume a diet low in calories, such as skim milk, fresh fruits, and vegetables."
"You must consume a diet high in carbohydrates, such as bread, potatoes, and pasta."
"You must consume a diet low in fat by limiting dairy products and concentrated sweets." - correct answer "You must consume a diet rich in protein, such as chicken, fish, and beans." Explanation:
The nurse encourages a client with a lung abscess to eat a diet that is high in protein and calories in order to ensure proper nutritional intake. A carbohydrate-dense diet or diets with limited fats are not advisable for a client with a lung abscess.
Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Lung Abscess, pp. 551-552.
The most diagnostic clinical symptom of pleurisy is:
Dullness or flatness on percussion over areas of collected fluid.
Dyspnea and coughing.
Fever and chills.
Stabbing pain during respiratory movements. - correct answer Stabbing pain during respiratory movements. Explanation:
The key characteristic of pleuritic pain is its relationship to respiratory movement: taking a deep breath, coughing, or sneezing worsens the pain. Pleuritic pain is limited in distribution rather than diffuse; it usually occurs only on one side. The pain may become minimal or absent when the breath is held; leading to rapid shallow breathing. It may be localized or radiate to the shoulder or abdomen. Later, as pleural fluid accumulates, the pain decreases.
Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, PLEURAL DISORDERS, Pleurisy, p. 553.
