ADULT HEALTH 1

ADULT HEALTH 1 - RESPIRATORY MED SURG ADULT HEALTH 1 -Respiratory med surg The nurse explains that the purpose of mucus is to: a. warm the air entering the lungs. b. trap particles and bacteria. c. protect the cilia. d. clean the sinus cavity. B Mucus traps particles and bacteria that may be in the inspired air. A patient with emphysema presents to the emergency room with severe dyspnea; O2 saturation is 74%, pulse is 120, and respirations are 26 . The nurse positions the patient in high Fowler. What action should the nurse take next? a. Collect a sputum specimen. b. Coach the patient in pursed-lip breathing. c. Give oxygen at 5 L/min by nasal cannula. d. Ensure patent intravenous (IV) access. B Coaching in pursed-lip breathing will open the respiratory tree with negative pressure. Oxygen given at such a high concentration will cause an emphysemic patient to stop breathing. Collecting a sputum specimen and ensuring patent IV access are appropriate interventions that should be performed after the patient's dyspnea is addressed. The nurse explains that the mechanism that triggers rate and depth of respiration is based on which factor? a. Ease of respiration. b. Alveolar pressure. c. Patency of bronchi. d. Blood pH. D Chemoreceptors in the brainstem and carotid arteries measure hydrogen concentration, as well as CO2 and O2, to trigger respiration rate to correct the excessive CO2. When creating a visual aid to show the mechanics of inhaling, the nurse correctly illustrates which scenario? a. The diaphragm moves downward. b. The negative pressure of the lung converts to positive pressure. c. The muscles contract and pull the rib cage downward. d. The bronchi enlarge. A On inspiration, the diaphragm moves down, increasing the area of negative pressure, muscles pull the rib cage up, and the positive-pressure room air flows into the negative-pressure lungs. The nurse explains that the substance that decreases the surface tension of the alveolar walls is: a. plasma. b. surfactant. c. cilia. d. mucus. B Surfactant is the substance that reduces the surface tension of the walls of the alveoli, making gas exchange more effective. Most of the inspired oxygen is carried to the tissues via which component of the body? a. Plasma b. Lymphatic system c. Red blood cells d. White blood cells C The red blood cells carry 97% of the oxygen to the cells, attached to hemoglobin. The nurse is caring for a patient with an obstructive respiratory disorder. Which of these conditions is an example of an obstructive lung disorder? a. Atelectasis b. Lung cancer c. Guillain-Barré syndrome d. Chronic bronchitis D Obstructive lung disease is related to the reduced ability to move air in and out of the lungs. Asthma, emphysema, and chronic bronchitis are classified as obstructive disorders. Atelectasis, lung cancer, and Guillain-Barré syndrome are restrictive disorders. When reviewing risk factors, the nurse correctly identifies which patient as having the greatest risk of throat cancer? a. The patient who drinks 4 cups of coffee per day. b. The patient who smokes 1 pack of cigarettes per week. c. The patient who drinks several carbonated drinks per day. d. The patient who drinks 4 vodka tonics per day. D The combination of alcohol and cigarettes increases the risk for throat cancer. However, the patient consuming 4 vodka drinks per day is at a higher risk than the patient smoking 1 pack of cigarettes per week. Coffee and carbonated drink consumption has not been found to increase the risk of throat cancer. The nurse is preparing to administer the influenza immunization to four patients. Allergy to which substance should cause the nurse to question giving the immunization? a. Strawberries b. Ragweed c. Penicillin d. Eggs D The influenza vaccine is cultured in chicken embryos, making anyone allergic to eggs probably allergic to the immunization. When the nurse places the diaphragm of the stethoscope over one of the main bronchi, the expected normal breath sound heard is: a. bronchovesicular. b. bronchial. c. rhonchi. d. vesicular. A Bronchovesicular sounds are moderate hollow sounds that are equal on inspiration and expira-tion. The nurse is performing deep tracheal suctioning of a patient with a respiratory disorder. Which action demonstrates appropriate technique? a. The nurse maintains clean technique. b. The nurse places the patient in a side-lying position. c. The nurse suctions the patient for 10 to 15 seconds. d. The nurse reassures the patient that he will feel no discomfort. C The suctioning, which is done during extraction of the suction tip, should not last more than 10 to 15 seconds as it deprives the patient of oxygen. Deep tracheal suction requires sterile tech-nique, and the patient should be positioned with the neck slightly extended to facilitate entrance into the trachea. Even though the procedure does not last for a long time, suctioning is uncom-fortable for the patient. The nurse is aware that the patient is in respiratory failure when the blood gas findings are a PaO2 of mm Hg and a PaCO2 of mm Hg. a. 46; 52 b. 50; 45 c. 52; 42 d. 55; 58 A Respiratory failure is defined by blood gases that have a PaO2 level below 50 mm Hg and a Pa-CO2 level equal to or higher than 50 mm Hg. Upgrade to remove ads Only $3.99/month The nurse assesses a patient's respirations who was recently admitted with a traumatic head injury. The nurse expects to find which type of breathing during the assessment? a. Apneustic respiration b. Cheyne-Stokes c. Kussmaul's d. Biot's D Biot's respirations are characterized by irregular periods of apnea followed by four to five breaths of identical depth. This pattern is associated with increased intracranial pressure, which is common with a traumatic head injury. Apneustic respirations are indicative of damage to the respiratory centers in the brain. Cheyne-Stokes respirations are often seen in patients in a coma resulting from a disorder affecting the central nervous system. Kussmaul's respiration is an ab-normal breathing pattern often seen in patients with diabetic acidosis and coma. The nurse is caring for a postoperative patient. After instructing the patient to cough and deep-breathe, what action should the nurse take next? a. Offer a warm drink. b. Perform mouth care. c. Deliver oxygen by mask. d. Take the patient's temperature. B Mouth care should be offered after deep breathing and coughing to clear the mouth of unpleasant taste. A patient is admitted to the medical unit with an acute illness accompanied by a fever for the last 3 days. What will likely be the patient's respiratory response? a. Hypercarbia b. Respiratory alkalosis c. Kussmaul respirations d. Respiratory acidosis B Respiratory alkalosis, or hypocapnia, results from the patient's respiratory rate being elevated for a prolonged period due to the persistent fever. The patient blows off too much CO2 as a result. Hypercarbia and respiratory acidosis are the same and result from disorders that cause hypoven-tilation. Kussmaul respirations are an abnormal breathing pattern. The nurse is caring for a patient with COPD who has been in the hospital for several days. The patient complains of shortness of breath and asks the nurse to turn up his oxygen to compensate for his labored breathing. What is the best nursing response? a. Turn up the patient's oxygen flow by 1 liter. b. Call the physician for an order to turn up the oxygen. c. Assess the patient in an attempt to identify the cause of the shortness of breath. d. Ask the patient what he usually keeps his oxygen set on at home. C The nurse should assess the patient for possible causes of the shortness of breath before calling the physician. The nurse may be able to implement nursing interventions, or may need to contact the physician for orders based on the assessment findings. Since the COPD patient's respiratory drive is lowering levels of PO2, turning up the oxygen may take away his incentive to breathe. Asking the patient about his home oxygen is not helpful at this point. The nurse uses a visual aid to show the "hinged door" that helps prevent aspiration. This "hinged door" is the . Fill in the blanks with correct word epiglottis The epiglottis is the "hinged door" that closes upon swallowing and opens when breathing. Rapid opening and closing of the glottis combined with movement of the mouth, lips, and tongue is what makes . Fill in the blanks with correct word speech or words The rapid opening and closing of the glottis combined with the movement of the mouth, lips, and tongue is what makes speech/ Words The nurse describes the ability of the lungs to respond to change in the volume and pressure of inhaled air by expanding as lung . Fill in the blanks with correct word compliance The lungs normal expansion in response to inhaled air is known as lung expansion. Lung com-pliance first increases and then decreases with age as the lungs become stiffer and the chest wall becomes more rigid. The nurse clarifies that when interstitial edema occurs in the lung tissue, it inhibits ventilation by causing which problem(s)? (Select all that apply.) a. Thickening alveolar membranes b. Pus formation c. Alveoli filling with fluid d. Evaporating surfactant e. Gas failing to diffuse across membrane A, C, E Interstitial edema will cause problems that affect the alveoli: thickened walls and filling with fluid that obstructs gas exchange across the thickened walls. Pus formation is associated with infection. Surfactant decreases surface tension on the alveolar wall, allowing it to expand more easily with inspiration and preventing alveolar collapse on expiration. Which manifestation(s) are age-related changes that alter the respiratory system? (Select all that apply.) a. Weakened cough b. Kyphosis c. Increased ciliary movement d. Decrease in body fluid e. Muscle weakness A, B, D, E Age-related changes in the respiratory system include weakened cough, kyphosis, decreased bo-dily fluids, and increased muscle weakness. Age often decreases ciliary movement. For which individual(s) does U.S. Public Health Service recommend the influenza immunization? (Select all that apply.) a. Physicians b. Compromised infants c. Older adults d. Chronically ill e. Nurses A, C, D, E Health care workers, older adults, and chronically ill individuals are at risk for contracting in-fluenza and should be immunized. Compromised infants should not be immunized. The nurse notes physical signs of labored breathing, which include: (Select all that apply.) a. grunting on expiration. b. elevating shoulders and ribs on inspiration. c. tensing neck and shoulder muscles. d. substernal retraction. e. productive cough. A, B, C, D Productive cough is not a sign of labored breathing. All other options are often seen with labor-ing respirations. The nurse explains that anorexia in the patient with a respiratory disorder may be attributed to: (Select all that apply.) a. increased sense of taste. b. bad taste in mouth. c. fear that eating will exacerbate coughing. d. fatigue. e. altered sense of smell. B, C, D, E The sense of taste is usually altered in the patient with a respiratory disorder. All of the other factors contribute to lack of appetite in the patient with a respiratory disorder. The nurse reminds the patient that a cold is contagious for about days. a. 2 b. 3 c. 4 d. 7 B The contagion period of a viral cold is about 3 days. The nurse is caring for a patient with suspected sinusitis. Which assessment finding supports this diagnosis? a. Maxillary sinuses nontender on percussion. b. Generalized pain in the upper teeth. c. Clear drainage from the ear. d. Ear pain when lying down B Sinusitis is an inflammation of the mucosal lining of the sinuses. Exudate accumulates in the si-nuses and pressure builds, which causes pain. Symptoms include painful upper teeth, tenderness over the sinuses, purulent drainage from the nose, nasal obstruction, and sometimes a nonpro-ductive cough. Drainage from the ear and ear pain when supine are findings likely consistent with an ear infection. The nurse is caring for a patient who has had a cold for 1 week. The patient questions why the health care provider issued a prescription for an antibiotic. Which explanation is best? a. "The antibiotic will cure your cold." b. "The antibiotic will help to reduce your symptoms." c. "The antibiotic will treat the secondary bacterial infection that has developed." d. "The antibiotic will decrease the amount of time for which you are contagious. C If a cold persists for more than a week to 10 days without improvement, a bacterial infection is present and requires medical treatment. While the etiology of a cold is viral in nature, antibiotics are necessary to this secondary bacterial infection. No cure exists for a cold. Antibiotics will not reduce symptoms of a cold or decrease the contagion period for a cold. A 6 year old had a tonsillectomy today. When the nurse goes into the room to give him his antibiotics, she finds him irritable, coughing, nauseated, and swallowing repeatedly. What is the next action the nurse should take? 1. Assess for signs of frank red blood in the mouth and nose and get a complete set of vital signs. 2. Ask the child for a pain score and if he would like a popsicle with his pain medicine. 3. Suction mouth vigorously to avoid aspiration of blood, and then hang antibiotic. 4. Take a complete set of vital signs and divert the child's attention to the cartoon on TV. 1 Feedback 1. This intervention assesses for bleeding. 2. An assessment for blood needs to occur because the child continues to swallow. 3. Suctioning can cause clots to loosen and increases bleeding. It should be avoided. 4. Vital signs are needed and a focused assessment needs to be completed in order to identify complications. The nurse is caring for a patient with sleep apnea. The patient complains that he is constantly fatigued. Which response is most appropriate for the nurse to make? a. "Patients with sleep apnea experience oxygen overloads, which lead to drowsi-ness." b. "Patients with sleep apnea often wake frequently during the night." c. "Patients with mild sleep apnea benefit from a small amount of red wine right before bed." d. "All patients have difficulty sleeping properly in the hospital." B Periods of apnea followed by abrupt intake of air frequently awaken the patient and reduce the amount of rapid eye movement (REM) sleep. Patients with sleep apnea experience oxygen defi-ciency. Mild apnea may be treated with conservative measures like avoiding alcohol 4 to 6 hours before bed. Telling the patient that all patients sleep poorly in the hospital ignores the patient's concern and makes an overgeneralization based on the nurse's bias. The nurse is caring for a patient during the immediate postoperative period following a rhinoplasty. The nurse is most concerned with which assessment finding? a. The patient complains of being cold and chilled. b. The patient complains of nausea. c. The nurse notices the patient swallowing frequently. d. The patient has a decreased fluid intake. C Frequent swallowing indicates bleeding that is trickling down the back of the throat. Feeling cold and chilly is a common symptom with surgery and is related to anesthetic and the cool surgical environment. Nausea may be experienced by some patients due to anesthetic. Fluid intake is not a symptom. The nurse instructs the laryngectomized patient that, in order to warm the inspired air during cold weather, the patient should: a. place hand over stoma. b. use scarf to cover stoma. c. wear moist dressing over stoma. d. stay in area of humidified air. B The fold of the scarf retains body heat and can warm air as the air passes through the scarf. The nurse is caring for a patient who underwent a laryngectomy. Which need should the nurse address first? a. Pain control b. Family support c. Communication method d. Plan for long-term care C Pain control and family support are important, but the need of a method of communication is paramount for a new tracheostomy patient to allay anxiety, ensure accurate communication between the patient and the nurse, and make the patient comfortable that nursing staff are attentive. The need for long-term care may not be necessary. When teaching a patient about esophageal speech, which technique should the nurse instruct the patient to use first? a. Coordinate lip and tongue movements with produced sound. b. Relax the diaphragm to allow air into the esophagus. c. Cough to express air. d. Swallow air and force it back up through the esophagus. D Many people are able to learn esophageal speech. First, the patient should master the art of swallowing air and then moving it forcibly back up through the esophagus. Next, the patient should learn to coordinate lip and tongue movements with the sound produced by the air passing over vibrating folds of the esophagus. The sounds may be somewhat hoarse, but are more natural than the sounds produced by an artificial larynx. Relaxing the diaphragm and coughing to ex-press air are not methods to achieve esophageal speech. The nurse is careful to apply suction prior to deflating the cuff on a cuffed tracheostomy in order to prevent: a. bleeding. b. excessive negative pressure. c. accidental dislodgement of the tube. d. aspiration. D By suctioning prior to deflating the cuff, the oral liquids that are trapped above the balloon can-not be aspirated. Bleeding, negative pressure, and dislodgement of the tube are not related to cuff inflation. When doing routine cleaning of a double-lumen tracheostomy tube, the nurse will include which of the following actions? a. Place the patient flat on the bed. b. Reinsert the inner cannula without touch-ing the faceplate of the tracheostomy tube. c. Rinse the inner cannula in a basin of hy-drogen peroxide. d. Clean the inner cannula with a pipe clean-er. D The inner cannula is cleaned with a pipe cleaner, the patient is put in the semi-Fowler's position, and the inner cannula is rinsed in sterile saline or sterile water, rather than peroxide. The nurse is caring for a patient experiencing epistaxis. What action should the nurse take first? a. Obtain the patient's vital signs. b. Firmly pack the nostrils with gauze. c. Apply a cold compress. d. Instruct the patient to sit forward and pinch the nose below the bone. D When epistaxis occurs, the patient should sit forward and apply direct pressure by pinching the nose just below the bone, close to the face for 10 to 15 minutes. This position prevents blood from running down the back of the throat. Cold compresses or ice may be applied to the nose to constrict the blood vessels. If there is still bleeding at the end of a 10- to 15-minute period, the process should be repeated. If bleeding continues, the nurse should obtain the patient's vital signs and notify the provider. The provider may cauterize the bleeding vessels or solidly pack the nose. The nurse is aware that the patient seeking antibiotic treatment for pharyngitis will only receive the desired medication if the condition is caused by what type of pathogen? a. Protozoa b. Bacteria c. A virus d. Fungi B Pharyngitis (sore throat) will be treated with an antibiotic only if the infection is deemed bacterial in etiology. Protozoa, viruses, and fungi do not respond to antibiotics. The nurse is assisting the physician with insertion of a new tracheostomy tube. The physician asks for the obturator. The nurse correctly hands the physician which device? a. The guide for the tracheostomy tube to be inserted b. The scalpel used to make the tracheotomy stoma c. A single-cannula tracheostomy tube d. A cuffed tracheostomy tube A The obturator is used during insertion of a tracheostomy tube as a guide to protect against scrap-ing the sides of the trachea with the sharp edge of the tube. The nurse encourages a patient with cancer of the larynx that the "near-total laryngectomy" is a new procedure that preserves the ability to and to . speak; swallow swallow; speak The new technique does not rob the patient of the ability to speak or swallow, which makes rehabilitation easier. The nurse advises that, to reduce the risk of giving a cold to another, one should: (Select all that apply.) a. cover the mouth and nose when sneezing. b. wash the hands frequently. c. use saline nose sprays. d. turn the head to the crook of the arm when coughing. e. drink juices with vitamin C. A, B, D Covering the mouth and nose when sneezing and coughing as well as frequent washing of hands will reduce the risk of passing a cold to another. Using saline sprays and drinking juices with vi-tamin C are not helpful in containing a cold. Which organism(s) are common causative agents for sinusitis? (Select all that apply.) a. Pneumococci b. Pseudomonas c. Staphylococci d. Haemophilus influenzae e. Streptococci A, D, E The common organisms causing sinusitis are pneumococci, Haemophilus influenzae, and strep-tococci. The nurse is teaching an adult post-tonsillectomy patient. Which dietary instructions are most important for the nurse to include? (Select all that apply.) a. Increase intake of citrus fruits. b. Avoid hot fluids. c. Avoid milk products. d. Avoid foods with red dye. e. Use a straw to drink liquids. B, D Avoiding red colored foods can help in distinguishing between ingested food and blood. Milk products are acceptable for post-tonsillectomy patient. Citrus fruits should be avoided until the throat has completely healed. Hot fluids should be avoided until the throat completely heals. Straws are not used because sucking may cause bleeding. The nurse is assessing an older adult with a family tendency of developing laryngeal cancer. The nurse should ask the patient about which risk factors? (Select all that apply.) a. History of smoking b. Alcohol abuse c. Exposure to asbestos d. Occupational exposure to wood dust e. Infection with Streptococcus bacteria A, B, C, D Cigarette smoking, alcohol abuse, asbestos exposure, and wood dust exposure are risk factors linked to laryngeal cancer. Streptococcus bacteria are not considered a risk factor for laryngeal cancer; infection with human papillomavirus or Helicobacter pylori has been linked to increased incidence of cancer of the larynx. The nurse includes in the discharge instruction to a patient who has had a microlaryngoscopy with laser removal of polyps to: (Select all that apply.) a. be alert for massive swelling. b. return to work in 3 days. c. cough to expectorate blood. d. observe 2 days of voice rest. e. take opioids for pain. B, D Observation of voice rest for 2 days and return to work in 3 days are the basic instructions. There is minimal swelling or bleeding, and NSAIDs (not opioids) are used for pain control. The nurse setting up the environment for tracheal suction on a newly postoperative tracheostomy patient will: (Select all that apply.) a. auscultate lungs for retained secretions. b. wash hands and open sterile suction kit. c. don clean gloves and lift out catheter and connect to suction. d. don sterile gloves and prepare solutions from kit. e. perform suction with sterile supplies. A, B, D, E Sterile rather than clean gloves should be worn during the suctioning procedure. All other options are significant to perform suctioning safely and aseptically. The radical neck resection removes a large amount of tissue on the same side as the lesion. The tissues removed include: (Select all that apply.) a. all muscle, lymph nodes, and soft tissue from the lower edge of the mandible to the top of the clavicle. b. all muscle, lymph nodes, and soft tissue from the top of the trapezius to the mid-line. c. all muscle, lymph nodes, and soft tissue from the lower edge of the eye socket to the bottom of the maxilla, including the zygomatic arch. d. part of the tongue and parotid salivary glands. e. lower lip to midline. A, B, C The radical neck resection does not ordinarily include the tongue, parotid salivary glands, or lip. The nurse is teaching a patient with a newly resolved episode of epistaxis. Which information is important for the nurse to include? (Select all that apply.) a. Avoid sneezing. b. Rest for several hours until all threat of epistaxis is gone. c. Avoid rubbing the nose. d. Gently remove clotted blood from the oc-cluded nostril. e. Blow the nose gently in small breaths. A, B, C The patient should avoid sneezing, rest for several hours, and avoid rubbing the nose. The patient should not attempt to remove clotted blood or blow the nose. The clinic nurse is giving discharge instructions to the mother of a 10-year-old boy who has been diagnosed with a mild cold. Which statements indicate that the mother accurately understands the nurse's instructions? (Select all that apply.) a. "I will be sure he takes the entire prescrip-tion of antibiotic." b. "I will be sure he drinks plenty of apple and orange juice." c. "If he runs a fever, I will give him two aspirin every 4 hours until his fever comes down." d. "I will be sure he washes his hands well so he doesn't pass this cold on to his younger sister." e. "Since his cold symptoms just started, zinc lozenges may be helpful for him to take." B, D, E Increasing fruit and citrus juice intake may decrease the duration or severity of a cold. Proper hand hygiene decreases the likelihood of transmission. According to Singh and Das (2013), if started with conjunction of symptom onset, zinc lozenges have proven effective in limiting a cold's duration and severity. Antibiotics are not used for colds (because colds are viral in etiolo-gy) unless a secondary infection is present or there is an increased risk for a secondary infection. Aspirin should not be given to children under age 12 due an increased risk for Reye syndrome. The patient with acute bronchitis asks if antibiotics will be ordered for the condition. Which response is best for the nurse to make? a. "Antibiotics are the best treatment op-tion." b. "Antibiotics will not help a viral condi-tion." c. "Antibiotics will be given if the sputum culture indicates your bronchitis is caused by bacteria." d. "Antibiotics will inhibit the inflammatory response of your body to the invasion of this infection." C Bronchitis is treated symptomatically with humidification and cough medications. Antibiotics are only given if the sputum culture suggests it. The nurse is assessing the patient with influenza. The patient reports having general malaise and aching muscles over the past 2 weeks. The nurse suspects that the patient may have developed which complication of influenza? a. Bronchitis b. Bacterial pneumonia c. Urinary infection d. Encephalitis B Bacterial pneumonia is a common complication of influenza and may present with atypical symptoms of only general malaise and muscle aches, making it difficult to recognize the symp-toms of pneumonia. Bronchitis, urinary infections, and encephalitis are not common complica-tions of influenza. The nurse explains that treatment with amantadine (Symmetrel) will: a. prevent viral pneumonia if taken regularly. b. stop viral spread of avian flu if taken at the first signs and symptoms of disease. c. lessen the severity of type A flu symptoms if taken within 48 hours of exposure. d. reduce irritation of bronchitis if taken weekly. ANS: C Amantadine (Symmetrel) is an antiviral medication that may be given within 48 hours of exposure or within 48 hours of the onset of influenza symptoms. It is not a drug that is taken regularly and will not stop the spread of the avian flu. The nurse differentiates viral from bacterial pneumonia in that viral pneumonia causes: a. elevation in white count. b. consolidation of lung tissue. c. interstitial inflammation. d. copious exudate. ANS: C Viral pneumonia causes interstitial inflammation with attendant edema. White count will not be elevated, and no exudate is consolidating the lung as with bacterial pneumonia. The 79-year-old patient with bacterial pneumonia becomes increasingly restless and confused. Temperature is 100° F and pulse, blood pressure, and respirations are elevated since the last assessment 6 hours ago. The initial intervention by the nurse should be to: a. take the patient off oral fluids. b. assess oxygen saturation. c. give the ordered mild sedative. d. administer an NSAID for discomfort. ANS: B Assessing the oxygen saturation will reveal the level of oxygenation. These are early signs of hypoxia in the older adult. Medications for sedation or discomfort do not address the patient's current condition. There is no indication for stopping oral fluids The 75-year-old patient asks the nurse if the Pneumovax immunization he took when he was 65 is still protecting him. The nurse's most helpful reply is: a. "Yes. Pneumovax protects you for your lifetime." b. "No. The immunity afforded you by Pneumovax lasts only 2 years." c. "Yes, but it loses strength and may not protect you from all 23 pneumococcal organisms anymore." d. "No. A second dose is needed 6 years after the first for full immunity." ANS: D Pneumovax, an immunization that protects against 23 pneumococcal organisms, is repeated 6 years after the first dose. The 75-year-old resident in the nursing home who cares for 40 birds in an aviary complains of shortness of breath and fatigue and a dry cough. Based on this information, the nurse suspects the resident may be suffering from: a. coccidioidomycosis. b. histoplasmosis. c. tuberculosis. d. atypical pneumonia. ANS: B Histoplasmosis is caused by a fungus that lives in bird droppings. The symptoms are dry cough, shortness of breath, and fatigue. Coccidioidomycosis is contracted by people who engage in desert recreational activities or are working in occupations that require digging in the earth. Tuberculosis and atypical pneumonia are not supported by the resident's history and symptoms. The 30-year-old American Indian female who is taking Rifater, a drug containing rifampin, isoniazid, and pyrazinamide, complains that she is tired of taking medicine and having to spit in a bottle all the time. She asks, "When can I stop all this and get on with my life?" The nurse's best response is that she will no longer be considered contagious when: a. the sputum culture comes back negative. b. the medication has been taken for 9 months. c. three consecutive sputum cultures are negative. d. the tuberculin skin test (TST) is no longer positive. ANS: C This drug is given to treat active tuberculosis. The active tuberculosis patient is considered noncontagious when three consecutive sputum cultures are negative. Taking the medication for a given period of time does not make the patient noncontagious. The TST will always be positive. The nurse reading a tuberculin skin test (TST) on a new employee who lives in the Midwest, is 20 years old, and has no known history of contact with any persons with tuberculosis (TB) will record it as positive if the area around the injection site has an area of swelling of mm hours after the injection. a. 15; 48 b. 10; 72 c. 5; 48 d. 0 to 5; 72 ANS: A All TSTs are read at 48 to 72 hours after the injection. A positive reading of a TST for a person who is low risk for exposure is an area of swelling 15 mm or more. For individuals who are at high risk for TB (such as recent immigrants from countries where TB is prevalent, medically underserved groups, and the homeless), swelling of more than 10 mm is considered positive. Individuals with a history of contact with infectious TB or who are immunocompromised are considered to have a positive TST if there is more than 5 mm of swelling. The nurse explains that a serious complication of a patient's chronic obstructive pulmonary disease (COPD) is cor pulmonale, which is exhibited by: a. distended neck veins. b. weight loss. c. confusion and disorientation. d. excessive coughing. ANS: A Cor pulmonale is exhibited by distended neck veins, enlarged right side of the heart, liver engorgement, and edema. The patient with asthma is prescribed a leukotriene modifier drug, montelukast (Singulair). The nurse points out that the major advantage of this drug is it: a. has no GI side effects. b. provides bronchodilation and anti-inflammatory effects. c. controls acute asthma episodes. d. can be substituted for all other asthma remedies. ANS: B Singulair provides both bronchodilation and anti-inflammatory effects, but it has numerous GI side effects and is not effective in controlling acute asthmatic attacks. The patient with chronic airflow limitation (CAL) changed to the use of a simple face mask from a nasal cannula delivery system. The nasal equipment oxygen was set at 3 L/min. The nurse instructs the patient that, with the change in delivery systems, the oxygen should be L/min. a. decreased to 2 b. decreased to 1 c. increased to 4 d. increased to 6 ANS: D When changing to a mask from a nasal cannula, the oxygen should be increased by approximately 100% to get the same concentration. Simple face masks deliver approximately the same range of concentration of oxygen as the nasal cannula. However, the nasal cannula flow rates range from 1 L to 6 L, delivering 24% to 44% oxygen, whereas the simple face mask delivers 35% to 50% oxygen which is achieved with flow rates from 6 L to 12 L. A patient who has had a left pneumonectomy to remove a lung cancer is returned to the unit from surgery. The nurse should position the patient in a position. a. high Fowler's b. semi-Fowler's c. right side-lying d. left side-lying ANS: D Postoperative positioning after a pneumonectomy is on the operated side to prevent the threat of tension pneumothorax with mediastinal shift and leakage from the amputated bronchial stump. The physician's order should always be checked before turning the patient or raising the head of the bed. When caring for a patient who is on a closed-chest drainage system with chest tubes, the nurse can confirm that the system is intact and working when: a. the water level in the water-seal chamber fluctuates. b. the level of fluid in the collection chamber rises. c. there are constant bubbles in the water-seal chamber. d. the suction has been attached. ANS: A If the level of the water in the water-seal chamber rises and falls with the patient's respiration, the system is intact. Constant bubbles in the water-seal chamber indicate a leak in the system. The fluid in the collection container drains by gravity whether the closed-chest drainage system is intact or not. Suction is not significant with respect to whether the system is intact When the nurse assesses that the level of drainage has not increased over the last 3 hours on a first-day postoperative thoracotomy patient, the nurse should initially: a. inform the charge nurse. b. rearrange tubing to correct dependent loops. c. splint the patient with a pillow and coach to cough. d. gently massage the tube toward the collection bottle. ANS: B Dependent loops can capture drainage and plug the tube, not allowing any more drainage to leave the chest. Massaging (milking) the tube can be implemented after the dependent loops have been corrected. It would not be necessary to notify the charge nurse unless there is a problem, and having the patient cough would not correct the drainage problem. The nurse schedules the postural drainage treatments to be done before breakfast because: a. fluids that have accumulated overnight can be expelled. b. bronchial openings are still more fully open after a night's rest. c. appetite will be stimulated for a meal after fluid is expelled. d. the empty stomach reduces gagging. ANS: A Morning postural drainage can expel the fluids collected overnight. After a postural drainage, the patient is tired and may not want to eat at all. The empty stomach prevents excessive vomiting but not gagging. The patient with sleep apnea is fitted with a continuous positive airway pressure (CPAP) mask and asks the nurse how this device will help. The nurse correctly responds with which statement? a. "The device delivers constant positive pressure to keep your airway open." b. "The device will require you to be intubated to open your airway." c. "The device delivers oxygen only when you are apneic." d. "The device delivers negative pressure to stimulate your respirations." ANS: A The CPAP mask delivers a constant positive pressure to keep the airway open. CPAP does not require intubation and does not deliver negative pressure. When caring for a patient with AIDS, the nurse is aware that this patient is most at risk for developing which type of pneumonia? a. Hypostatic b. Streptococcus pneumoniae c. Atypical d. Pneumocystis jiroveci ANS: D Pneumocystis jiroveci (formerly known as Pneumocystis carinii) is commonly seen in AIDS patients. Hypostatic pneumonia is related to inadequate aeration of the lungs seen frequently with immobile patients. Streptococcus pneumoniae is the most common causative organism for bacterial pneumonia in the general population. Atypical pneumonia refers to pneumonia that does not present with the typical symptoms of pneumonia. The nurse is teaching an asthma patient proper use of the peak flowmeter. The nurse determines further teaching is needed when observing which action by the patient? a. Repeating the procedure for a total of three readings b. Breathing in deeply through the mouthpiece c. Standing while performing the test d. Recording the highest reading on the peak flow sheet ANS: B Peak flow should be monitored on a daily basis to determine if the asthma patient has adequate airflow. The reading helps determine if treatment should be adjusted. The patient should stand to achieve adequate chest expansion while taking a deep breath. The patient then blows as hard and fast as possible into the device with the mouthpiece in the mouth and the lips clamped firmly around it for a tight seal. The procedure should be performed three times with the highest reading recorded. The nurse providing patient education states that influenza is spread by: (Select all that apply.) a. direct contact. b. indirect contact. c. vector. d. blood-borne method. e. droplets. ANS: A, B, E Influenza is not spread by vectors or the blood-borne method. The home health nurse making an initial call on a newly diagnosed tuberculosis patient who lives at home with his wife and child would give special instruction for infection control to: (Select all that apply.) a. place contaminated tissues in sealable plastic bag. b. take prescribed drug exactly as directed. c. take airborne precautions. d. wash hands frequently. e. wear mask when in crowds. ANS: A, B, D, E As the family is already exposed, taking airborne precautions is unnecessary. The nurse is performing an occupational history as part of the respiratory assessment. Which occupation(s) place the patient at increased risk for an occupational lung disorder? (Select all that apply.) a. A firefighter b. A cotton gin worker c. A construction contractor d. A bartender e. A landscaper A, B, C Firefighters, cotton gin workers, and construction contractors all come into contact with occupa-tional hazards that could increase risks for lung disorders. Coal dust, dust from hemp, flax, and cotton processing, and exposure to silica in the air all can cause work-related lung disorders. As-bestos exposure may cause mesothelioma and scarring of lung tissue. The other exposures cause obstruction of small airways or scarring and loss of elasticity and compliance. A bartender and landscaper are not at increased risk of occupational lung disorders. The signs the nurse would expect to see in a patient with advanced emphysema are: (Select all that apply.) a. productive cough. b. dyspnea. c. barrel chest. d. wheezing. e. cyanotic skin tone. ANS: A, B, C, E The emphysemic has a barrel chest and dyspnea. There is minimal coughing and mucus production until late in the disease. Wheezing usually does not occur in the emphysemic patient. Cyanosis is usually absent until late in the disease when the patient becomes hypoxic. The home health nurse recommends to the 60-year-old patient with emphysema who is anorexic to enhance her nutrition by the practices of: (Select all that apply.) a. resting before eating. b. avoiding gas-producing food. c. eating four to six small meals rather than three large ones. d. lying down after eating. e. taking small bites and chewing slowly. ANS: A, B, C, E Lying down after meals will likely increase shortness of breath. All other options will enhance her ability to increase her nutritional state. The nurse explains to the patient on a mechanical ventilator that it is set on assist-control mode, which means that the machine will: (Select all that apply.) a. deliver a set tidal volume. b. deliver a set number of breaths if the patient's rate falls. c. automatically cuts off if the patient is breathing independently. d. deliver more oxygen at the end of an inspiration. e. help to correct respiratory acidosis. ANS: A, B The assist-control mode delivers a set tidal volume on every respiration and will deliver a set number of breaths per minute should the patient's rate drop. It does not cut off automatically or deliver more oxygen at the end of the inspiration, nor does it correct respiratory acidosis. The nurse is preparing a presentation highlighting the benefits of annual influenza vaccination. The nurse correctly targets which groups? (Select all that apply.) a. The parents of children 3 to 6 months of age b. Diabetics who are over 50 years old c. Pregnant women d. Home health aides e. CNAs who work in long-term care facilities ANS: B, C, D, E Children ages 6 to 59 months should receive the influenza vaccine, not children 3 to 6 months of age. The Advisory Committee on Immunization Practices also suggests that pregnant women, people over age 50, and people with certain chronic illnesses receive the vaccine. In addition, health care workers and those caring for persons in homes that are at high risk for contracting influenza should receive the vaccine.