Chapter 27: Lower Respiratory Problems
Lewis: Medical-Surgical Nursing, 10th
Edition
A lobectomy is scheduled for a patient with stage I non-small cellular lung cancer. The patient
tells the nurse, "I could alternatively have chemotherapy than surgical treatment." Which
response by way of the nurse is maximum appropriate?
A. "Are you afraid that the surgery will be very painful?"
b. "Did you've got terrible stories with preceding surgical procedures?"
c. "Tell me what you already know approximately the remedies available."
d. "Surgery is the remedy of desire for degree I lung most cancers." - ANS-ANS: C
More evaluation of the patient's worries about surgical procedure is indicated. An open-ended
response will elicit the maximum records from the patient. The answer beginning, "Surgery is
the treatment of desire" is accurate, but it discourages the affected person from sharing worries
approximately surgical operation. The last two solutions suggest that the nurse has jumped to
conclusions approximately the patient's motives for no longer trying surgical procedure.
Chemotherapy is the number one treatment for small cell lung cancer. In non-small cell lung
cancer, chemotherapy may be used within the treatment of nonresectable tumors or as adjuvant
remedy to surgical operation.
DIF: Cognitive Level: Analyze (evaluation)
A affected person identified with energetic tuberculosis (TB) is homeless and has a records of
alcohol abuse. Which intervention by the nurse might be most effective in ensuring adherence
with the treatment routine?
A. Repeat warnings about the excessive danger for infecting others numerous instances.
B. Give the patient written commands approximately a way to take the medicines.
C. Arrange for a day by day meal and drug management at a network middle.
D. Arrange for the affected person's buddy to manage the medication on agenda. - ANS-ANS: C
Directly found therapy is the handiest approach for making sure compliance with the treatment
regimen, and arranging a each day meal will help make certain that the patient is to be had to
receive the medicine. The different nursing interventions can be appropriate for some patients
however aren't probable to be as helpful for this patient's scenario.
DIF: Cognitive Level: Analyze (evaluation)
A patient stories a chest wall contusion as a result of being struck in the chest with a baseball
bat. The emergency department nurse might be most worried if which finding is discovered at
some point of the initial evaluation?
A. Paradoxical chest movement
,b. Complaint of chest wall ache
c. Heart rate of a hundred and ten beats/minute
d. Large bruised region on the chest - ANS-ANS: A
Paradoxical chest motion suggests that the affected person may have flail chest, that can
critically compromise gas alternate and might rapidly cause hypoxemia. Chest wall ache, a
slightly accelerated pulse rate, and chest bruising all require further assessment or intervention,
however the priority situation is terrible fuel alternate.
DIF: Cognitive Level: Analyze (analysis)
A patient has acute bronchitis with a nonproductive cough and wheezes. Which topic should the
nurse plan to consist of in the teaching plan?
A. Purpose of antibiotic remedy
b. Ways to restriction oral fluid consumption
c. Appropriate use of cough suppressants
d. Safety concerns with home O2 remedy - ANS-ANS: C
Cough suppressants are regularly prescribed for acute bronchitis. Because maximum acute
bronchitis is viral in origin, antibiotics aren't prescribed unless there are systemic signs and
symptoms. Fluid consumption is advocated. Home O2 isn't prescribed for acute bronchitis,
despite the fact that it can be used for persistent bronchitis.
DIF: Cognitive Level: Apply (software)
A affected person has simply been admitted with likely bacterial pneumonia and sepsis. Which
order need to the nurse put in force first?
A. Chest x-ray thru stretcher
b. Blood cultures from two sites
c. Ciprofloxacin (Cipro) four hundred mg IV
d. Acetaminophen (Tylenol) rectal suppository - ANS-ANS: B
Initiating antibiotic therapy rapidly is critical, however it's miles essential that the cultures be
received before antibiotic management. The chest x-ray and acetaminophen management may
be done remaining.
DIF: Cognitive Level: Analyze (analysis)
A patient is admitted to the emergency branch with an open stab wound to the left chest. What
action must the nurse take?
A. Keep the pinnacle of the affected person's mattress positioned flat.
B. Cover the wound tightly with an occlusive dressing.
C. Position the affected person in order that the left chest is dependent.
D. Tape a nonporous dressing on three aspects over the wound. - ANS-ANS: D
The dressing taped on 3 facets will permit air to break out while intrapleural stress will increase
during expiration, but it'll save you air from moving into the pleural area in the course of
proposal. Placing the affected person at the left aspect or protecting the chest wound with an
occlusive dressing will permit trapped air in the pleural space and cause anxiety pneumothorax.
The head of the mattress must be increased to 30 to 45 ranges to facilitate respiration.
, DIF: Cognitive Level: Apply (application)
A patient is admitted with lively tuberculosis (TB). The nurse ought to query a health care
issuer's order to stop airborne precautions until which evaluation finding is documented?
A. Chest x-ray suggests no upper lobe infiltrates.
B. TB medicinal drugs had been taken for 6 months.
C. Mantoux checking out shows an induration of 10 mm.
D. Sputum smears for acid-fast bacilli are bad. - ANS-ANS: D
Repeated bad sputum smears indicate that Mycobacterium tuberculosis is not present in the
sputum, and the affected person can't transmit the micro organism by the airborne route. Chest
x-rays are not used to determine whether remedy has been a success. Taking medicinal drugs
for six months is important, however the multidrug-resistant styles of the sickness might not be
eradicated after 6 months of therapy. Repeat Mantoux testing might now not be carried out due
to the fact the result will now not alternate inspite of effective remedy.
DIF: Cognitive Level: Apply (application)
A patient is identified with both human immunodeficiency virus (HIV) and energetic tuberculosis
(TB) ailment. Which statistics acquired by means of the nurse is maximum crucial to speak to
the health care issuer?
A. The Mantoux test had an induration of 7 mm.
B. The chest-x-ray confirmed infiltrates inside the lower lobes.
C. The patient has a cough this is efficient of blood-tinged mucus.
D. The patient is being treated with antiretrovirals for HIV contamination. - ANS-ANS: D
Drug interactions can occur between the antiretrovirals used to deal with HIV contamination and
the medicines used to deal with TB. The other information are expected in a patient with HIV
and TB.
DIF: Cognitive Level: Analyze (analysis)
A patient who has a proper-sided chest tube after a thoracotomy has non-stop effervescent in
the suction-control chamber of the gathering tool. Which movement with the aid of the nurse is
suitable?
A. Adjust the dial on the wall regulator.
B. Continue to monitor the collection tool.
C. Document the presence of a massive air leak.
D. Notify the doctor of a possible pneumothorax. - ANS-ANS: B
Continuous bubbling is expected inside the suction-control chamber and shows that the
suction-manipulate chamber is attached to suction. An air leak would be detected in the
water-seal chamber. There is not any evidence of pneumothorax. Increasing or decreasing the
vacuum source will not adjust the suction pressure. The quantity of suction applied is regulated
by the quantity of water in this chamber and no longer by the quantity of suction applied to the
system.
DIF: Cognitive Level: Apply (utility)
Lewis: Medical-Surgical Nursing, 10th
Edition
A lobectomy is scheduled for a patient with stage I non-small cellular lung cancer. The patient
tells the nurse, "I could alternatively have chemotherapy than surgical treatment." Which
response by way of the nurse is maximum appropriate?
A. "Are you afraid that the surgery will be very painful?"
b. "Did you've got terrible stories with preceding surgical procedures?"
c. "Tell me what you already know approximately the remedies available."
d. "Surgery is the remedy of desire for degree I lung most cancers." - ANS-ANS: C
More evaluation of the patient's worries about surgical procedure is indicated. An open-ended
response will elicit the maximum records from the patient. The answer beginning, "Surgery is
the treatment of desire" is accurate, but it discourages the affected person from sharing worries
approximately surgical operation. The last two solutions suggest that the nurse has jumped to
conclusions approximately the patient's motives for no longer trying surgical procedure.
Chemotherapy is the number one treatment for small cell lung cancer. In non-small cell lung
cancer, chemotherapy may be used within the treatment of nonresectable tumors or as adjuvant
remedy to surgical operation.
DIF: Cognitive Level: Analyze (evaluation)
A affected person identified with energetic tuberculosis (TB) is homeless and has a records of
alcohol abuse. Which intervention by the nurse might be most effective in ensuring adherence
with the treatment routine?
A. Repeat warnings about the excessive danger for infecting others numerous instances.
B. Give the patient written commands approximately a way to take the medicines.
C. Arrange for a day by day meal and drug management at a network middle.
D. Arrange for the affected person's buddy to manage the medication on agenda. - ANS-ANS: C
Directly found therapy is the handiest approach for making sure compliance with the treatment
regimen, and arranging a each day meal will help make certain that the patient is to be had to
receive the medicine. The different nursing interventions can be appropriate for some patients
however aren't probable to be as helpful for this patient's scenario.
DIF: Cognitive Level: Analyze (evaluation)
A patient stories a chest wall contusion as a result of being struck in the chest with a baseball
bat. The emergency department nurse might be most worried if which finding is discovered at
some point of the initial evaluation?
A. Paradoxical chest movement
,b. Complaint of chest wall ache
c. Heart rate of a hundred and ten beats/minute
d. Large bruised region on the chest - ANS-ANS: A
Paradoxical chest motion suggests that the affected person may have flail chest, that can
critically compromise gas alternate and might rapidly cause hypoxemia. Chest wall ache, a
slightly accelerated pulse rate, and chest bruising all require further assessment or intervention,
however the priority situation is terrible fuel alternate.
DIF: Cognitive Level: Analyze (analysis)
A patient has acute bronchitis with a nonproductive cough and wheezes. Which topic should the
nurse plan to consist of in the teaching plan?
A. Purpose of antibiotic remedy
b. Ways to restriction oral fluid consumption
c. Appropriate use of cough suppressants
d. Safety concerns with home O2 remedy - ANS-ANS: C
Cough suppressants are regularly prescribed for acute bronchitis. Because maximum acute
bronchitis is viral in origin, antibiotics aren't prescribed unless there are systemic signs and
symptoms. Fluid consumption is advocated. Home O2 isn't prescribed for acute bronchitis,
despite the fact that it can be used for persistent bronchitis.
DIF: Cognitive Level: Apply (software)
A affected person has simply been admitted with likely bacterial pneumonia and sepsis. Which
order need to the nurse put in force first?
A. Chest x-ray thru stretcher
b. Blood cultures from two sites
c. Ciprofloxacin (Cipro) four hundred mg IV
d. Acetaminophen (Tylenol) rectal suppository - ANS-ANS: B
Initiating antibiotic therapy rapidly is critical, however it's miles essential that the cultures be
received before antibiotic management. The chest x-ray and acetaminophen management may
be done remaining.
DIF: Cognitive Level: Analyze (analysis)
A patient is admitted to the emergency branch with an open stab wound to the left chest. What
action must the nurse take?
A. Keep the pinnacle of the affected person's mattress positioned flat.
B. Cover the wound tightly with an occlusive dressing.
C. Position the affected person in order that the left chest is dependent.
D. Tape a nonporous dressing on three aspects over the wound. - ANS-ANS: D
The dressing taped on 3 facets will permit air to break out while intrapleural stress will increase
during expiration, but it'll save you air from moving into the pleural area in the course of
proposal. Placing the affected person at the left aspect or protecting the chest wound with an
occlusive dressing will permit trapped air in the pleural space and cause anxiety pneumothorax.
The head of the mattress must be increased to 30 to 45 ranges to facilitate respiration.
, DIF: Cognitive Level: Apply (application)
A patient is admitted with lively tuberculosis (TB). The nurse ought to query a health care
issuer's order to stop airborne precautions until which evaluation finding is documented?
A. Chest x-ray suggests no upper lobe infiltrates.
B. TB medicinal drugs had been taken for 6 months.
C. Mantoux checking out shows an induration of 10 mm.
D. Sputum smears for acid-fast bacilli are bad. - ANS-ANS: D
Repeated bad sputum smears indicate that Mycobacterium tuberculosis is not present in the
sputum, and the affected person can't transmit the micro organism by the airborne route. Chest
x-rays are not used to determine whether remedy has been a success. Taking medicinal drugs
for six months is important, however the multidrug-resistant styles of the sickness might not be
eradicated after 6 months of therapy. Repeat Mantoux testing might now not be carried out due
to the fact the result will now not alternate inspite of effective remedy.
DIF: Cognitive Level: Apply (application)
A patient is identified with both human immunodeficiency virus (HIV) and energetic tuberculosis
(TB) ailment. Which statistics acquired by means of the nurse is maximum crucial to speak to
the health care issuer?
A. The Mantoux test had an induration of 7 mm.
B. The chest-x-ray confirmed infiltrates inside the lower lobes.
C. The patient has a cough this is efficient of blood-tinged mucus.
D. The patient is being treated with antiretrovirals for HIV contamination. - ANS-ANS: D
Drug interactions can occur between the antiretrovirals used to deal with HIV contamination and
the medicines used to deal with TB. The other information are expected in a patient with HIV
and TB.
DIF: Cognitive Level: Analyze (analysis)
A patient who has a proper-sided chest tube after a thoracotomy has non-stop effervescent in
the suction-control chamber of the gathering tool. Which movement with the aid of the nurse is
suitable?
A. Adjust the dial on the wall regulator.
B. Continue to monitor the collection tool.
C. Document the presence of a massive air leak.
D. Notify the doctor of a possible pneumothorax. - ANS-ANS: B
Continuous bubbling is expected inside the suction-control chamber and shows that the
suction-manipulate chamber is attached to suction. An air leak would be detected in the
water-seal chamber. There is not any evidence of pneumothorax. Increasing or decreasing the
vacuum source will not adjust the suction pressure. The quantity of suction applied is regulated
by the quantity of water in this chamber and no longer by the quantity of suction applied to the
system.
DIF: Cognitive Level: Apply (utility)
