Deck 30: Nursing Management: Lower Respiratory Problems

Question 1

Four days after admission,a patient with chronic obstructive lung disease is diagnosed with hospital-acquired pneumonia (HAP).Which of the following organisms does the nurse recognize is a common cause of this type of pneumonia?

A) Pneumocystis carinii
B) Haemophilus influenzae
C) Pseudomonas aeruginosa
D) Mycoplasma pneumoniae

Answer 1

Pseudomonas aeruginosa

Question 2

What should the nurse teach patients at risk for pneumonia to obtain?

A) Staphylococcal vaccine
B) Measles,mumps,rubella (MMR)vaccine
C) Pneumococcal vaccine
D) Bacille Calmette-Guérin (BCG)vaccine

Answer 2

Pneumococcal vaccine

Question 3

During assessment of the patient with pneumonia,what does the nurse understand about the disease?

A) All patients with pneumonia will have a productive cough.
B) Manifestations of pneumonia vary,depending on the causative organism.
C) The typical pneumonia symptoms are usually caused by M.pneumoniae.
D) The pathophysiology of the disease is the same,regardless of the causative microorganism.

Answer 3

Manifestations of pneumonia vary,depending on the causative organism.

Question 4

A patient has just been started on chemotherapy for TB.What should the nurse tell the patient regarding how long the disease can be transmitted to others?

A) Until the night sweats have subsided
B) Until three AFB smears are negative
C) Until the medications have been taken for 6 months
D) Until sputum cultures on 3 consecutive days are negative

Question 5

A patient being treated for TB comes to the clinic after 2 months for a follow-up visit.Sputum smears for AFB are still positive.A sputum specimen is taken for culture and to determine whether the microorganism is sensitive to the medications.What knowledge does the nurse use to question the patient regarding the treatment regimen?

A) DOT will be necessary if the patient has been noncompliant.
B) A combination product of INH,rifampin,and pyrazinamide is indicated if the patient skips doses.
C) Treatment protocols involving twice-weekly administration of the drugs are not as effective as daily administration.
D) If the drugs are causing side effects,a regimen including the administration of only INH can be substituted.

Question 6

A patient diagnosed with TB is started on initial drug therapy.Which of the following medications should the nurse plan to teach the patient about the uses and effects of?

A) INH,rifampin,and ethambutol
B) INH,pyrazinamide,and streptomycin
C) INH,rifampin,pyrazinamide,streptomycin,and ethambutol
D) Para-aminosalicylic acid,ethambutol,rifampin,and pyrazinamide

Question 7

A hospitalized patient who may have tuberculosis (TB)has an order for a sputum specimen.When will be the best time for the nurse to collect the specimen?

A) After the patient rinses the mouth with mouthwash
B) As soon as the order is received from the physician
C) Right after the patient gets up in the morning
D) After the skin test is administered

Question 8

To promote airway clearance in a patient with pleurisy,what should the nurse instruct the patient to do?

A) Splint the chest when coughing.
B) Maintain a semi-Fowler's position.
C) Wear the nasal oxygen cannula at all times.
D) Use relaxation techniques to reduce anxiety.

Question 9

During assessment of the chest in a patient with pneumococcal pneumonia,what would the nurse expect to find?

A) Hyperresonance on percussion
B) Increased tactile fremitus on palpation
C) Fine crackles in all lobes on auscultation
D) Asymmetrical chest expansion on inspection

Question 10

The nurse is preparing a patient with a diagnosis of bronchiectasis for chest physiotherapy with postural drainage.Which one of the following will the nurse implement?

A) Position the patient supine.
B) Elevate the head of the bed by 20 cm.
C) Elevate the foot of the bed by 10 to 15 cm.
D) Ensure the patient is in the left lateral position for the first part of the chest physiotherapy.

Question 11

Following discharge teaching,the nurse evaluates that the patient with pneumonia understands measures to prevent a relapse of the pneumonia when the patient gives which of the following responses?

A) "I will increase my food intake to 2400 calories a day."
B) "I must use home oxygen therapy for 3 months."
C) "I will seek medical treatment for any upper respiratory infections."
D) "I should continue to do deep breathing and coughing exercises for at least 6 weeks."

Question 12

To protect susceptible patients in the hospital from aspiration pneumonia,what must the nurse do?

A) Turn and reposition immobile patients every 2 hours.
B) Position patients with altered consciousness in a lateral position.
C) Monitor for respiratory symptoms in those patients who are immunosuppressed.
D) Plan room assignments to prevent infected patients from placement with surgical patients.

Question 13

A 56-year-old normally healthy patient at the clinic is diagnosed with community-acquired pneumonia.The nurse anticipates that empirical treatment of the patient could include the administration of which of the following medications?

A) Ciprofloxacin (Cipro)
B) Azithromycin (Zithromax)
C) Trimethoprim-sulfamethoxazole (Bactrim)
D) A second- or third-generation cephalosporin

Question 14

During intravenous (IV)administration of amphotericin B ordered for treatment of coccidioidomycosis,how can the nurse increase the patient's tolerance of the drug?

A) Cooling the solution to 26.7°C before administration
B) Keeping the patient flat in bed for 1 hour after the infusion is completed
C) Diluting the amphotericin B in 500 mL of distilled water before administering
D) Administering diphenhydramine (Benadryl)1 hour before the infusion

Question 15

A homeless patient with alcoholism is diagnosed with active TB.Which nursing intervention will be most effective in ensuring adherence to the treatment regimen?

A) Giving the patient written instructions about how to take the medications
B) Teaching the patient about the high risk for infecting others unless treatment is followed
C) Arranging for a daily noontime meal at a community centre and giving the medication then
D) Educating the patient about the long-term impact of TB on health

Question 16

The nurse recognizes that the goals of teaching regarding the transmission of TB have been met when the patient with TB carries out which of the following actions?

A) Wears a mask when in contact with others
B) Reports daily to the public health department
C) Boils dishes and personal items between uses
D) Covers the mouth and nose when coughing or sneezing

Question 17

A staff nurse has a TB skin test of 16-mm induration.A chest radiograph is negative,and the nurse has no symptoms of TB.The occupational health nurse will plan on teaching the staff nurse about which of the following?

A) Use and side effects of INH
B) Standard four-medication therapy for TB
C) Need for annual repeat TB skin testing
D) Recommendation guidelines for BCG vaccine

Question 18

Which of the following is a general term used for lung diseases caused by the inhalation and retention of dust particles?

A) Berylliosis
B) Byssinosis
C) Paraneoplastic syndrome
D) Pneumoconiosis

Question 19

A patient is receiving isoniazid (INH)after having a positive tuberculin skin test.Which information will the nurse include in the patient teaching plan?

A) "Take vitamin B₆ daily to prevent peripheral nerve damage."
B) "Read a newspaper daily to check for changes in vision."
C) "Schedule an audiometric examination to monitor for hearing loss."
D) "Avoid wearing soft contact lenses to avoid orange staining."

Question 20

Following assessment of a patient with pneumonia,the nurse documents a nursing diagnosis of ineffective airway clearance.On which of the following data would the nurse base this nursing diagnosis?

A) SpO₂ of 85%
B) Respiratory rate of 28 breaths/min
C) Presence of greenish sputum
D) Weak,nonproductive cough

Question 21

The nurse establishes the presence of a tension pneumothorax when assessment findings reveal which of the following results?

A) Decreased breath sounds on the affected side
B) Inability to auscultate tracheal breath sounds
C) A sucking sound with each patient breath
D) A shift of the point of maximal impulse to the left,with bounding pulses

Question 22

In relation to lung cancer and gender,which of the following statements is true?

A) More women than men are diagnosed with lung cancer.
B) Men are more likely to develop small-cell carcinoma than women.
C) Women develop lung cancer after fewer years of smoking than men do.
D) Lung cancer incidence and deaths are increasing in men.

Question 23

When developing a teaching plan for a patient with a 42-pack-year history of cigarette smoking,it will be most important for the nurse to include information about which of the following?

A) Reasons for annual sputum cytology testing
B) Computed tomography screening for lung cancer
C) Erlotinib (Tarceva)therapy to prevent tumour risk
D) Options for smoking cessation

Question 24

A 52-year-old patient has a 40-pack-year history of smoking and has been diagnosed with cancer of the lung.He tells the nurse that he did not know that anything was wrong until he had a routine chest X-ray.The nurse explains that symptoms of lung cancer occur late in the disease.What is the first thing people usually notice?

A) Fatigue
B) Chest pain
C) A persistent cough
D) Shortness of breath

Question 25

A 68-year-old man has a long history of chronic obstructive pulmonary disease and is admitted to the hospital with cor pulmonale.Which clinical manifestation noted by the nurse is would indicate that the patient with a diagnosis of cor pulmonale also has heart failure?

A) Audible crackles at both lung bases
B) Peripheral edema
C) Loud murmur at the mitral area
D) High systemic blood pressure

Question 26

The nurse identifies a nursing diagnosis of ineffective airway clearance for a patient who has incisional pain,a poor cough effort,and expiratory wheezing after having a pneumonectomy.To promote airway clearance,what is the nurse's initial action?

A) Have the patient use the incentive spirometer.
B) Medicate the patient with the ordered morphine.
C) Splint the patient's chest during coughing.
D) Assist the patient to sit up at the bedside.

Question 27

A patient who was admitted the previous day with pneumonia complains of a sharp pain whenever he takes a deep breath.Which action will the nurse take next?

A) Listen to the patient's lungs.
B) Check the patient's O₂ saturation.
C) Have the patient cough forcefully.
D) Notify the patient's health care provider.

Question 28

After discharge teaching has been completed for a patient who has had a lung transplant,the nurse will evaluate that the teaching has been effective if the patient states which of the following?

A) "I will make an appointment to see the doctor every year."
B) "I will not turn the home oxygen up higher than 2 L/min."
C) "I will be careful to use sterile technique with my central line."
D) "I will write down my medications and spirometry in a journal."

Question 29

A patient with primary pulmonary hypertension (PPH)is on diuretic therapy.The nurse will evaluate that the treatment is effective in which of the following situations?

A) The patient reports decreased exertional dyspnea.
B) The blood pressure is less than 140/90 mm Hg.
C) The heart rate is between 60 and 100 beats/min.
D) The patient's chest X-ray indicates clear lung fields.

Question 30

Which of the following is an extrapulmonary cause of restrictive lung disease?

A) Kyphoscoliosis
B) Atelectasis
C) Interstitial lung disease
D) Tuberculosis

Question 31

A lobectomy is scheduled for a patient with squamous cell carcinoma of the lung.The patient tells the nurse,"I would rather have radiation than surgery." What is the most appropriate response?

A) "Are you afraid that the surgery will be very painful?"
B) "Tell me what you know about the various treatments available."
C) "Surgery is the treatment of choice for stage I lung cancer."
D) "Did you have bad experiences with previous surgeries?"

Question 32

A patient is scheduled for a thoracentesis to obtain pleural fluid for diagnosis of a large pleural effusion.Before the procedure,the nurse will anticipate which of the following?

A) Position the patient sitting upright on the edge of the bed and leaning forward.
B) Instruct the patient about the importance of incentive spirometer use after the procedure.
C) Start a peripheral IV line to administer the necessary sedative drugs.
D) Remove the water pitcher and remind the patient not to eat or drink anything for 8 hours.

Question 33

A patient has a chest tube following a thoracotomy.Continuous bubbling in the suction-control chamber of the collection device would alert the nurse to which of the following facts?

A) An air leak may be present.
B) The lung has fully expanded.
C) The unit is functioning normally.
D) A tension pneumothorax is developing.

Question 34

The nurse is performing TB screening in a clinic that has many patients who have immigrated to Canada.Before doing a TB skin test on a patient,which question is most important for the nurse to ask?

A) "How long have you lived in Canada?"
B) "Do you have a family history of TB?"
C) "Have you received the BCG vaccine for TB?"
D) "Do you take any over-the-counter medications?"

Question 35

A patient experiences a flail chest as a result of an automobile accident.During the respiratory assessment,what would the nurse expect to find?

A) Bloody sputum
B) Laryngeal stridor
C) Deep,irregular respirations
D) Paradoxical chest movement

Question 36

A young man is admitted to the emergency department with a stab wound to the right chest.He has moderate bleeding from the site,and his vital signs show symptoms of shock.Air can be heard entering his chest with each inspiration.To decrease the possibility of a tension pneumothorax in the patient,what should the nurse do?

A) Position the patient on his injured side.
B) Administer high-flow oxygen using a nonrebreathing mask.
C) Cover the sucking chest wound with a petrolatum gauze dressing.
D) Apply a nonporous dressing taped on three sides to the chest wound.

Question 37

When caring for a patient who is hospitalized with active TB,the nurse observes a family member who is visiting the patient.The nurse will need to intervene if the family member does which of the following?

A) Washes the hands before entering the patient's room
B) Puts on a surgical face mask before visiting the patient
C) Brings food from a "fast-food" restaurant to the patient
D) Hands the patient a tissue from the box at the bedside

Question 38

When providing preoperative instruction for a patient scheduled for a left pneumonectomy for cancer of the lung,the nurse informs the patient that postoperatively he can expect which of the following interventions?

A) To be positioned on the unaffected side
B) Chest tubes to water-seal chest drainage
C) Endotracheal intubation with mechanical ventilation
D) Frequent use of an incentive spirometer

Question 39

The physician inserts two chest tubes connected with a Y-connecter in a patient with a hemopneumothorax.When monitoring the patient after the chest tube placement,the nurse will be concerned about which of the following?

A) A large air leak in the water-seal chamber
B) 400 mL of blood in the collection chamber
C) Severe pain with each deep patient inspiration
D) Subcutaneous emphysema at the insertion site

Question 40

The occupational nurse at a manufacturing plant where there is high worker exposure to beryllium dust will monitor workers for which of the following?

A) Shortness of breath
B) Stabbing chest pain
C) Elevated temperature
D) Barrel chest

Question 41

The nurse obtains the following information when caring for a patient receiving subcutaneous heparin injections to treat a pulmonary embolus.Which assessment information is most important to communicate to the physician?

A) The patient has many abdominal bruises.
B) The patient's blood pressure is 90/46 mm Hg.
C) The activated partial thromboplastin time is two times the patient baseline.
D) The patient's stool is dark green and liquid.

Question 42

The nurse is preparing a patient for discharge after treatment for a pulmonary embolism.The patient asks the nurse how long he will have to be on anticoagulant therapy.The nurse's response is based on knowledge that the patient will be on this therapy for which period of time?

A) 10 days post discharge
B) 2 to 4 weeks
C) 3 to 6 months
D) 6 to 8 months

Question 43

The nurse has received a change-of-shift report about these four patients.Which one will the nurse plan to assess first?

A) A 23-year-old patient with cystic fibrosis who has pulmonary function testing scheduled in 30 minutes
B) A 35-year-old patient who was admitted the previous day with bacterial pneumonia and has a temperature of 38.5°C
C) A 46-year-old patient who is complaining of dyspnea after having a thoracentesis an hour previously
D) A 77-year-old patient with TB who has four antitubercular medications due in 15 minutes

Question 44

A patient with a chronic productive cough and weight loss is receiving a TB skin test and asks the nurse the reason for the test.Which response should the nurse give?

A) "The skin test will determine if you have a TB infection."
B) "The skin test will indicate whether you have active TB."
C) "The skin test is used to decide which antibiotic therapy will work best."
D) "The skin test is done before notification of the public health department."

Question 45

Which assessment information obtained by the nurse when caring for a patient who has just had a thoracentesis is most important to communicate to the physician?

A) Blood pressure is 150/90 mm Hg.
B) Pain level is 5 on a 10-point scale with a deep breath.
C) Oxygen saturation is 89%.
D) Respiratory rate is 24 breaths/min when lying flat.

Question 46

All of the following orders are received for a patient who has just been admitted with probable bacterial pneumonia and sepsis.Which one will the nurse accomplish first?

A) Obtain blood cultures from two sites.
B) Give ciprofloxacin (Cipro)400 mg IV.
C) Send patient to have a chest radiograph.
D) Administer an aspirin suppository.

Question 47

A patient with a deep-vein thrombophlebitis complains of sudden chest pain and difficulty breathing.The nurse finds a heart rate of 142 beats/min,blood pressure of 100/60 mm Hg,and respiration of 42 breaths/min.The nurse's first action should be to do which of the following?

A) Elevate the head of the bed.
B) Administer the ordered pain medication.
C) Notify the patient's health care provider.
D) Offer emotional support and reassurance.