ATI MED SURG PROCTORED EXAM 2020 WITH NGN QUESTIONS & ANSWERS WITH RATIONALES

The nurse assesses a patient with emphysema and notes a barrel chest. What is the reason for this patient's chest anomaly? - Hyperinflation of the lungs Rationale: A patient with emphysema develops a barrel chest as a result of the trapping of air in the lungs, which causes them to hyperinflate. Collapsed alveoli, use of accessory muscles, and long-term, chronic hypoxia do not cause a barrel chest. The nurse notes that the respiratory symptoms of the patient with chronic obstructive pulmonary disease (COPD) have affected his nutrition. Which would most help improve the patient's nutrition? - Extra protein is required to repair damaged tissues Rationale: Nutrition is very important for the patient with COPD because the extra work to breathe properly uses more calories and anorexia may be present. Extra protein is required to repair damaged tissues. It is helpful to drink six to eight glasses of noncaffeinated fluids per day to keep mucus thin and easier to cough up, unless the physician has the patient on a fluid restriction. The patient should rest before eating, not exercise before meals. The patient should avoid overeating and should eat four to six small meals a day rather than three regular meals to decrease stomach fullness and reduce fatigue. A patient with COPD asks the nurse to turn his oxygen up from 3 L/min via nasal cannula to 5 L/min. The nurse asseses the patient and finds that the oxygen saturation level is at 91%. The nurse explains to the patient that she cannot turn his oxygen up this high for what reason? - Oxygen is titrated to maintain saturation levels. Rationale: O2 should be titrated to maintain an oxygen saturation of 88% to 92%. COPD patients have adjusted to chronic hypoxia and to high CO2 levels. Closely monitor the pulse oximetry readings and titrate the oxygen as needed. Hypercapnia is the result of hypoventilation, during which the usual amount of carbon dioxide is not eliminated by exhalation. Carbon dioxide is a respiratory stimulant, and thenormal response to excessive levels of carbon dioxide is an increase in respiratory rate. Increasing the oxygen flow unnecessarily will not relieve increased respirations. Low oxygen levels, not high carbon dioxide levels, are the stimulus for breathing for a patient with COPD. Higher concentrations of oxygen will not be required for ABGs or result in a headache. A patient taking aminophylline tells the nurse that he is going to begin a smoking cessation program when he is discharged from the hospital. Why should the nurse tell this patient to notify his physician if his smoking pattern changes? - The patient will need his aminophylline dosage adjusted. Rationale: The length of the action of aminophylline is decreased by smoking. Therefore, changes in smoking patterns should be discussed with the physician or other health care provider because this may affect the dosage of aminophylline needed. Patients COPD are managed with expectorants, not antitussives. Annual influenza vaccine is recommended for all patients with lung disease. The patient should experience increased benefits from inhaler use following smoking cessation. A patient with emphysema may lose weight despite having an adequate caloric intake. What advice should the nurse give the patient regarding ways to maintain an optimal weight? - Increase calories, protein, vitamins, and minerals. Rationale: Due to the amount of energy expended for breathing, patients with emphysema often need additional calories, protein, vitamins, and minerals. Patients require more calories but not more fats. Increasing activity will increase oxygen demand and result in further weight loss. The student nurse is caring for a patient with a restrictive respiratory disease. Which description demonstrates the student's knowledge of the disease? - The disease is characterized by decreased lung expansion. Rationale :Restrictive respiratory disorders may be caused by decreased elasticity or compliance of the lungs, decreased ability of the chest wall to expand, or disorders of the central nervous system. Increased lung volumes, lung obstruction,or narrowed tracheobronchial tree openings are not characteristics of restrictive respiratory disease. A patient who experienced high fever and chills, a productive cough, chest pain, general malaise, and aching muscles during the past week is admitted to the hospital. The nurse realizes these symptoms correspond most closely with which disease? - Pneumonia Rationale: Typical signs and symptoms of pneumonia include high fever, chills, a cough that produces rusty or blood-flecked sputum, sweating, chest pain, a general feeling of malaise, and aching muscles. These symptoms do not describe type A influenza, pleurisy with effusion, or S. empyema infection. A patient with asthma is suddenly experiencing difficulty breathing, tachypnea, and wheezing. Which medication listed on the medication administration record, administered through an inhaler, should the nurse administer to this patient? - Albuterol Rationale: Albuterol is a fast-acting bronchodilator and can be given during an acute episode of asthma symptoms. Its onset of action is 5 to 10 minutes and its duration is 3 to 4 h. Cromolyn is an inhaled antiinflammatory agent that may take up to 2 weeks to produce a therapeutic effect. Salmeterol and formoterol are longacting bronchodilators that should not be used to treat acute episodes of asthma. The nurse is caring for a patient with viral pneumonia. Which intervention(s) should the nurse expect to be included in the care plan? Select all apply - -Providing adequate rest periods -Maintaining adequate fluid intake -Monitoring vital signs and respiratory status -providing oral hygiene before and after meals rationale: Antibiotics are effective only for bacterial, not viral, infections. Antibiotics would be given only for secondary bacterial infections. The care plan should include provision of adequate rest periods, maintaining adequate fluidintake, monitoring vital signs and respiratory status, and providing oral hygiene before and after meals.