Deck 62: Management of Clients with Parenchymal and Pleural Disorders

Question 1

The nurse would know that a client who has just begun treatment for pulmonary TB with rifampin has a good understanding of this medication with the statement that

A) "I told my wife to throw away all our spoons and forks before I come home."
B) "I won't go to any family gatherings for 6 months."
C) "It's going to be important to remember to cover my nose when I sneeze."
D) "My urine will look orange because of the medication."

Answer 1

"My urine will look orange because of the medication."

Question 2

The nurse caring for a client with cystic fibrosis would select as the highest priority the nursing diagnosis of

A) Activity Intolerance.
B) Anxiety.
C) Risk for Deficient Fluid Volume.
D) Risk for Ineffective Airway Clearance.

Answer 2

Risk for Ineffective Airway Clearance.

Question 3

On physical examination of a client with pneumonia, the nurse would expect

A) absence of whispered pectoriloquy over the affected area.
B) increased tactile fremitus over the affected area.
C) tympanic percussion notes over the affected area.
D) vesicular breath sounds over the affected area.

Answer 3

increased tactile fremitus over the affected area.

Question 4

In caring for a client scheduled to have chest tubes removed, the nurse's most appropriate action would be to

A) assist the client to a prone position.
B) empty the collection chambers before removal.
C) encourage deep breathing during removal.
D) medicate for pain 1/2 hour before removal.

Question 5

The nurse caring for a client recently diagnosed with active TB would include in the teaching plan which information regarding medications?

A) Clients must report daily to the health department to receive their medication.
B) Clients are usually admitted to the hospital to initiate treatment for TB.
C) Medications are generally given for 6 to 8 weeks.
D) TB is treated with three or more medications to prevent organism resistance.

Question 6

The nurse writing an infection control policy for a home health care agency would include the information that the rise in TB cases in recent years is related to the

A) aging of the U.S. population.
B) emergence of antibiotic-resistant bacteria.
C) increase in HIV infection.
D) rise in illegal drug use.

Question 7

The nurse would assess a client with severe acute respiratory syndrome (SARS) for the major clinical manifestation indicating the onset of the lower respiratory phase, which is

A) dry, nonproductive cough.
B) hemoptysis.
C) pleuritic pain.
D) rapid temperature elevation.

Question 8

To prevent the complication of atelectasis in an 82-year-old woman with a hip fracture, the nurse would

A) ambulate the client frequently.
B) frequently reposition the client.
C) suction the upper airway.
D) supply oxygen.

Question 9

A client had chest surgery this morning and has a chest tube attached to a closed-chest drainage system. When the nurse notes no tidaling of fluid, the nurse would first

A) attach the system to suction.
B) milk the chest tube.
C) notify the physician immediately.
D) reposition the client.

Question 10

The nurse notes that a client in a long-term care facility has become increasingly confused in the last few days. The resident's vital signs are temperature 97.7° F, pulse rate 80 beats/min, respirations 20 breaths/min, and blood pressure (90/62) mm Hg. The nurse would suspect

A) cancer of the lung.
B) plural effusion.
C) pneumonia.
D) tuberculosis (TB).

Question 11

A client is noncompliant with the continuation phase of treatment for TB. The nurse assigns the diagnosis Ineffective Coping and plans interventions that will

A) allow the client to continue to work from home.
B) increase the client's sense of control.
C) isolate the client from the family until the disease is under control.
D) require the client to report medication use.

Question 12

The nurse notes intermittent bubbling in the water-seal chamber of a chest tube in place for a client with pneumothorax. The nurse's most appropriate action is to

A) change the drainage unit.
B) clamp the chest tube.
C) encourage respiratory exercises.
D) place petrolatum gauze around the chest tube.

Question 13

The nurse would become concerned about the risk of hemorrhage if, in the first 2 hours after surgery, the thoracotomy client's drainage exceeded

A) 50 ml.
B) 100 ml.
C) 300 ml.
D) 750 ml.

Question 14

The nurse has made the nursing diagnosis Ineffective Breathing Pattern related to tachypnea secondary to chest pain for a client with pneumonia. After administration of an analgesic, the nurse would

A) encourage the use of an incentive spirometer.
B) monitor the client's respiratory pattern.
C) reposition the client flat in bed.
D) request that the client cough.

Question 15

A young female client with cystic fibrosis (CF) wishes to become pregnant but is concerned about the effect of CF on fertility. The nurse bases a response with the understanding that

A) breastfeeding will not be possible because of plugged milk glands.
B) only about 20% of women with CF are infertile.
C) pregnancy carries a high risk of spontaneous abortion (miscarriage).
D) women with CF are unlikely to become pregnant.

Question 16

A client has small cell carcinoma of the lung. The nurse should anticipate providing which intervention to the client?

A) Educating the client and family about planned chemotherapy
B) Instructing the client on home care of a chest tube system
C) Preparing the client for lung resection
D) Providing a referral to hospice

Question 17

The nurse would know that the client most likely to exhibit a false-negative Mantoux reaction is the client who is

A) being treated for sickle cell disease.
B) HIV-positive.
C) malnourished.
D) previously diagnosed with TB.

Question 18

A client has accidentally disconnected a chest tube while turning over in bed. The suction tubing is on the floor. The most appropriate action by the nurse is to

A) call the physician immediately and prepare the client for reinsertion.
B) clamp the chest tube just proximal to the open end.
C) reattach the drainage tube to the suction tubing.
D) submerge the end of the drainage tube in a bottle of sterile saline.

Question 19

The nurse administering influenza vaccinations to a group of office workers would not offer the vaccine to a client who

A) has a history of asthma.
B) is allergic to eggs.
C) is allergic to sulfa drugs.
D) takes amoxicillin for a bladder infection.

Question 20

To increase the level of comfort for a client with a lung abscess, the nurse would include which intervention in the care plan?

A) Encourage activity before meals.
B) Offer frequent oral hygiene.
C) Provide easy-to-eat milk products.
D) Restrict fluid intake.

Question 21

The nurse would explain that the client's diagnosis of interstitial pneumonia means

A) pus has accumulated in the major bronchi.
B) the alveoli are filled with fluid.
C) the small bronchioles are inflamed.
D) there is an inflammatory response in the tissue surrounding the air space.

Question 22

A client is hospitalized for an exacerbation of sarcoidosis. The nurse anticipates an order to administer

A) antipyretics.
B) corticosteroids.
C) high-dose antibiotics.
D) rifampin.

Question 23

A spinal cord-injured client complains of severe dyspnea in the side-lying position. The nurse anticipates diagnostic testing to reveal

A) a pleural abscess.
B) a tension pneumothorax.
C) bilateral diaphragmatic paralysis.
D) pneumonia.

Question 24

A client is being discharged after treatment for a bronchopleural fistula. Important self-care measures the nurse should teach include

A) improving the client's nutrition.
B) management of the chest tube system.
C) preventing a recurrence.
D) smoking cessation resources.

Question 25

A client with HIV infection has a history of close exposure to someone with active pulmonary tuberculosis and has developed a cough and low-grade fever. The client's Mantoux is negative but the client has been admitted to the hospital for further testing. The most appropriate action by the nurse is to (Select all that apply)

A) admit the client to a private room.
B) anticipate orders for AFB testing.
C) place the client in respiratory isolation.
D) screen potential roommates carefully.
E) select a room close to the nurses' station.

Question 26

A client has an interstitial lung disease (ILD) and has questions related to the disease process. The best explanation by the nurse is that ILD

A) causes alveolar walls to thicken and become nonfunctional.
B) is a highly contagious disease and close contacts need treatment.
C) is caused by a recurrent fungal infection in the lung parenchyma.
D) leads to diffuse intrapulmonary cavity formation.

Question 27

A client is admitted with flu-like symptoms that developed after hunting rabbits. The nurse anticipates which of the following initial orders for this client?

A) Intubation and mechanical ventilation
B) Mantoux TB testing
C) Rapid infusion of IV fluids
D) Respiratory isolation room

Question 28

Nurses caring for clients being treated for active pulmonary tuberculosis in the hospital are required to have (Select all that apply)

A) an annual chest x-ray.
B) an annual skin test for TB.
C) no allergies to anti-TB medications.
D) properly-fitting particulate respirators.

Question 29

A client is being evaluated for a lung transplant. The nurse assists the client to understand that the psychological assessment includes which of the following? (Select all that apply.)

A) Ability to cope with stress and coping mechanisms
B) History of compliance with medical regimen
C) History of substance abuse
D) Occupational and financial resources

Question 30

A client has undergone a pleurodesis. The priority nursing action after the procedure is to assess the client's

A) respiratory status.
B) urine output.
C) vital signs.
D) wound site.

Question 31

After the physician tells a client that pneumonia has caused the client's bilateral lobar atelectasis, the client anxiously asks the nurse, "Does that mean my lungs have collapsed?" The most informative response by the nurse would be the following:

A) "No, but your pneumonia has permanently damaged your lungs to the point they may never fully inflate."
B) "No; only a lobe in each side has collapsed, but they will inflate as the pneumonia resolves."
C) "Yes; both lungs have collapsed, but they are presently reinflating as your health improves."
D) "Yes; large portions of your lungs have collapsed, but the unaffected portions of your lungs will accommodate your oxygen needs."

Question 32

A client comes to the clinic complaining of shortness of breath with activity that has gradually gotten worse over several years. An important finding from the nursing history would be the client's

A) family history of lung cancer.
B) occupation as a coal miner.
C) previous treatment for "walking pneumonia."
D) recent move from the mountains.

Question 33

A client has been diagnosed with histoplasmosis lung infection. The nurse would anticipate treatment to include

A) amphotericin B.
B) corticosteroids.
C) isoniazid.
D) morphine.

Question 34

A nurse is planning care for a client who has an intrapulmonary restrictive lung disorder. The nurse chooses interventions with the understanding that treatment for this disease

A) can assist lung tissue in regenerating.
B) is best attained through surgery.
C) requires a long course of antibiotics.
D) will not reverse the disease process.