Med_Surg_Chapter_23

Med-Surg Ch 23: Management of Patients with Chest and Lower Respiratory Tract Disorders Question A 73-year-old client is admitted to the pulmonology unit of the hospital. She was admitted with a pleural effusion and was "tapped" to drain the fluid to reduce her mediastinal pressure. How much fluid is typically present between the pleurae, which surround the lungs, to prevent friction rub? • 5 – 15 ml Question A client admitted with multiple traumatic injuries receives massive fluid resuscitation. Later, the physician suspects that the client has aspirated stomach contents. The nurse knows that this client is at highest risk for: • acute respiratory distress syndrome (ARDS). Question A client admitted with pneumonia has a history of lung cancer and heart failure. A nurse caring for this client recognizes that he should maintain adequate fluid intake to keep secretions thin for ease in expectoration. The amount of fluid intake this client should maintain is: • 1.4 L. Question A client at risk for pneumonia has been ordered an influenza vaccine. Which statement from the nurse best explains the rationale for this vaccine? • “Viruses like influenza are the most common cause of pneumonia.” Question A client diagnosed with acute respiratory distress syndrome (ARDS) is restless and has a low oxygen saturation level. If the client’s condition does not improve and the oxygen saturation level continues to decrease, what procedure will the nurse expect to assist with in order to help the client breathe more easily? • Intubate the client and control breathing with mechanical ventilation Question A client has been hospitalized for treatment of acute bacterial pneumonia. Which outcome indicates an improvement in the client's condition? • The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher. Question A client has hypoxemia of pulmonary origin. What portion of arterial blood gas results is most useful in distinguishing between acute respiratory distress syndrome and acute respiratory failure? • Partial pressure of arterial oxygen (PaO2) Question A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care? • Encouraging increased fluid intake Question A client is admitted to the facility with a productive cough, night sweats, and a fever. Which action is most important in the initial care plan? • Placing the client in respiratory isolation Question A client is being discharged following pelvic surgery. What would be included in the patient care instructions to prevent the development of a pulmonary embolus? • Tense and relax muscles in the lower extremities. Question A client is brought to the emergency department following a motor vehicle accident. Which of the following nursing assessments is significant in diagnosing this client with flail chest? • Paradoxical chest movement Question A client with suspected severe acute respiratory syndrome (SARS) comes to the emergency department. Which physician order should the nurse implement first? • Institute isolation precautions. Question A client who has started therapy for drug-resistant tuberculosis demonstrates understanding of tuberculosis transmission when he says: • "I'll stop being contagious when I have a negative acid-fast bacilli test." Question A client who has just had a triple-lumen catheter placed in his right subclavian vein complains of chest pain and shortness of breath. His blood pressure is decreased from baseline and, on auscultation of his chest, the nurse notes unequal breath sounds. A chest X-ray is immediately ordered by the physician. What diagnosis should the nurse suspect? • Pneumothorax Question A client who underwent surgery 12 hours ago has difficulty breathing. He has petechiae over his chest and complains of acute chest pain. What action should the nurse take first? • Initiate oxygen therapy. Question A mediastinal shift occurs in which type of chest disorder? • Tension pneumothorax Question A nurse assesses arterial blood gas results for a patient in acute respiratory failure (ARF). Which results are consistent with this disorder? • pH 7.28, PaO2 50 mm Hg Question A nurse is assessing a client who comes to the clinic for care. Which findings in this client suggest bacterial pneumonia? • Dyspnea and wheezing Question A nurse is caring for a client who is at high risk for developing pneumonia. Which intervention should the nurse include on the client's care plan? • Using strict hand hygiene Question A nurse is caring for a client who was admitted with pneumonia, has a history of falls, and has skin lesions resulting from scratching. The priority nursing diagnosis for this client should be: • Ineffective airway clearance. Question A nurse is caring for a group of clients on a medical-surgical floor. Which client is at greatest risk for developing pneumonia? • A client with a nasogastric tube Question A nurse is caring for a patient diagnosed with empyema. Which of the following interventions does a nurse implement for patients with empyema? • Encourage breathing exercises. Question 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.” Question A nurse is reviewing a client's X-ray. The X-ray shows an endotracheal (ET) tube placed 3/4" (2 cm) above the carina and reveals nodular lesions and patchy infiltrates in the upper lobe. Which interpretation of the X-ray is accurate? • A disease process is present. Question A nurse reading a chart notes that the client had a Mantoux skin test result with no induration and a 1-mm area of ecchymosis. How does the nurse interpret this result? • Negative Question A patient arrives in the emergency department after being involved in a motor vehicle accident. The nurse observes paradoxical chest movement when removing the patient’s shirt. What does the nurse know that this finding indicates? • Flail chest Question A patient comes to the clinic with fever, cough, and chest discomfort. The nurse auscultates crackles in the left lower base of the lung and suspects that the patient may have pneumonia. What does the nurse know is the most common organism that causes community-acquired pneumonia? • Streptococcus pneumoniae Question A patient who wears contact lenses is to be placed on rifampin for tuberculosis therapy. What should the nurse tell the patient? • “You should switch to wearing your glasses while taking this medication.” Question A physician stated to the nurse that the client has fluid in the pleural space and will need a thoracentesis. The nurse expects the physician to document this fluid as • pleural effusion. Question A positive Mantoux test indicates that a client: • has produced an immune response. Question A victim has sustained a blunt force trauma to the chest. A pulmonary contusion is suspected. Which of the following clinical manifestations correlate with a moderate pulmonary contusion? • Blood-tinged sputum Question A victim of a motor vehicle accident has been brought to the emergency room. The patient is exhibiting paradoxical chest expansion and respiratory distress. Which of the following chest disorders should be suspected? • Flail chest Question After 48 hours, a Mantoux test is evaluated. At the site, there is a 10 mm induration. This finding would be considered: • Significant Question After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH [Laniazid]) as prophylaxis against tuberculosis. The client's daughter asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy? • 6 to 12 months Question An elderly client is diagnosed with pulmonary tuberculosis. Upset and tearful, he asks the nurse how long he must be separated from his family. Which nursing diagnosis is most appropriate for this client? • Deficient knowledge (disease process and treatment regimen) Question Arterial blood gas analysis would reveal which value related to acute respiratory failure? • pH 7.28 Question Class 1 with regard to TB indicates • exposure and no evidence of infection. Question During discharge teaching, a nurse is instructing a client about pneumonia. The client demonstrates his understanding of relapse when he states that he must: • continue to take antibiotics for the entire 10 days. Question Following thoracic surgery, what would be included in the care plan for a client at risk for impaired gas exchange? Select all that apply. • Monitor vital signs frequently. • Reinforce preoperative breathing exercises. • Elevate head of bed 30 to 40 degrees as tolerated. Question In a client with amyotrophic lateral sclerosis (ALS) and respiratory distress, which finding is the earliest sign of reduced oxygenation? • Increased restlessness Question In the prevention of occupational lung diseases, the nurse would direct preventive teaching to which high-risk occupations? Select all that apply. • Rock quarry worker • Miner Question On auscultation, which finding suggests a right pneumothorax? • Absence of breath sounds in the right thorax Question Resistance to a first-line antituberculotic agent in a client who has not received previous treatment is referred to as • primary drug resistance. Question The clinic nurse is caring for a client with acute bronchitis. The client asks what may have caused the infection. What may induce acute bronchitis? • Chemical irritation Question The most diagnostic clinical symptom of pleurisy is: • Stabbing pain during respiratory movements. Question The new client on the unit was admitted with acute respiratory failure. What are the signs and symptoms of acute respiratory failure? • Sudden onset in client who had normal lung function Question The nurse assesses a patient for a possible pulmonary embolism. What frequent sign of pulmonary embolus does the nurse anticipate finding on assessment? • Tachypnea Question The nurse caring for a client with tuberculosis anticipates administering which vitamin with isoniazid (INH) to prevent INH-associated peripheral neuropathy? • Vitamin B6 Question The nurse caring for a 2-year-old near-drowning victim monitors for what possible complication? • Acute respiratory distress syndrome Question The nurse is administering anticoagulant therapy with heparin. What International Normalized Ratio (INR) would the nurse know is within therapeutic range? • 2.0 to 2.5 Question The nurse is assessing a client’s potential for pulmonary emboli. What finding indicates possible deep vein thrombosis? • Localized calf tenderness Question The nurse is auscultating the patient’s lung sounds to determine the presence of pulmonary edema. What adventitious lung sounds are significant for pulmonary edema? • Crackles in the lung bases Question The nurse is caring for a client with tuberculosis. Why should the nurse always encourage a client with tuberculosis to perform active range-of-motion (ROM) exercises three times a day? • For maintaining muscle strength Question The nurse is caring for a patient with pleurisy. What symptoms does the nurse recognize are significant for this patient’s diagnosis? • Stabbing pain during respiratory movement Question The nurse is collaborating with a community group to develop plans to reduce the incidence of lung cancer in the community. Which of the following would be most effective? • Classes at community centers to teach about smoking cessation strategies Question 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? • 6 to 12 months Question The nurse is providing discharge instructions to a client with pulmonary sarcoidosis. The nurse concludes that the client understands the information if the client correctly mentions which early sign of exacerbation? • Shortness of breath Question The occupational nurse is completing routine assessments on the employees where you work. What might be revealed by a chest radiograph for a client with occupational lung diseases? • Fibrotic changes in lungs Question The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clamped during transportation? • Tension pneumothorax Question What dietary recommendations should a nurse provide a client with a lung abscess? • A diet rich in protein Question When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems? • Hypercapnia, hypoventilation, and hypoxemia Question Which action should the nurse take first in caring for a client during an acute asthma attack? • Administer bronchodilator as ordered. Question Which intervention does a nurse implement for clients with empyema? • Encourage breathing exercises Question Which is a key characteristic of pleurisy? • Pain Question Which should a nurse encourage in clients who are at the risk of pneumococcal and influenza infections? • Receiving vaccinations Question Which statement indicates a client understands teaching about the purified protein derivative (PPD) test for tuberculosis? • "Because I had a previous reaction to the test, this time I need to get a chest X-ray." Question Which statement would indicate that the parents of child with cystic fibrosis understand the disorder? • “The mucus-secreting glands are abnormal.” Question Which technique does the nurse suggest to a client with pleurisy while teaching about splinting the chest wall? • Turn onto the affected side. Question Which technique does a nurse suggest to a patient with pleurisy for splinting the chest wall? • Turn onto the affected side. Question Which vitamin is usually administered with isoniazid (INH) to prevent INH-associated peripheral neuropathy? • Vitamin B6 Question Which would be least likely to contribute to a case of hospital-acquired pneumonia? • A nurse washes her hands before beginning client care. Question While caring for a client with a chest tube, which nursing assessment would alert the nurse to a possible complication? • Crackling is heard when skin around tube is touched. Question You are assessing a client's potential for pulmonary emboli. What finding indicates possible deep vein thrombosis? • Pain in the calf Question You are caring for a client status post lung resection. When assessing your client you find that the bubbling in the water-seal chamber for the chest tubes is more than you expected. What should you check when bubbling in the water-seal chamber is excessive? • See if there are leaks in the system. Question 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 Question You are an occupational health nurse in a large ceramic manufacturing company. How would you intervene to prevent occupational lung disease in the employees of the company? • Fit all employees with protective masks.