Deck 36: Nursing Care of Patients with Ventilation Disorders

Question 1

Which of the following assessment findings would indicate that a victim of a motor vehicle accident is experiencing a pneumothorax?

A)hyperresonance to percussion at the apex of the left lung
B)dullness to percussion at the base of the left lung
C)crackles throughout the left lung
D)shallow breathing

Answer 1

hyperresonance to percussion at the apex of the left lung

Question 2

The nurse, caring for a patient diagnosed with severe acute respiratory syndrome (SARS), should assess for which of the following? Select all that apply.

A)nasal flaring
B)restlessness
C)anxiety
D)decreased level of consciousness
E)sputum production

Answer 2

nasal flaring
restlessness
anxiety
decreased level of consciousness

Question 3

A patient comes into the emergency department with acute shortness of breath and copious secretions. The patient states the problem started a few hours after arriving at work. Which of the following is the most likely cause of the patient's acute respiratory problem?

A)reaction to the agent used to clean the carpeting in the office
B)environmental air temperature 72 degrees
C)received annual flu vaccine one week ago
D)did not finish breakfast but had a protein bar for a snack

Answer 3

reaction to the agent used to clean the carpeting in the office

Question 4

The nurse caring for patients with end-stage lung disease determines that which of the following patients may qualify for single lung transplant?

A)62-year-old female with diabetes mellitus controlled by insulin therapy
B)50-year-old male with multi-vessel CAD and chronic renal insufficiency
C)32-year-old male patient with HIV
D)43-year-old female with hepatitis C confirmed by histologic findings of liver disease by biopsy

Question 5

Which of the following would the nurse assess in the patient with the nursing diagnosis of Ineffective Airway Clearance? Select all that apply.

A)Assess skin color at least every four hours.
B)Assess breath sounds at least every four hours.
C)Assess oxygen saturation level at least every four hours.
D)Assess vital signs daily.
E)Assess respiratory rates every shift.

Question 6

A patient diagnosed with a restrictive lung disease due to an intrinsic cause is least likely to demonstrate which of the following during an assessment?

A)chronic productive cough of prolonged duration
B)progressive exertional dyspnea
C)dry cough
D)hemoptysis

Question 7

A patient diagnosed with active tuberculosis is in a negative pressure room for respiratory airborne isolation. How long should the nurse maintain the patient in this type of isolation?

A)until three consecutive sputum specimens for acid fast bacilli are negative
B)until the Mantoux test (PPD) converts from positive to negative
C)until the patient has orders for discharge
D)until the chest x-ray is normal

Question 8

A clinic is being conducted to provide influenza (flu) and pneumonia vaccines for adults. Prior to administration of a flu vaccine, the nurse must assess for which of the following?

A)current antibiotic therapy
B)pulse oximeter saturation level
C)allergy to mercury
D)allergy to eggs

Question 9

Which of the following clinical manifestations is not expected in a patient diagnosed with an occupational lung disease?

A)wet sounding crackles in the lungs
B)chronic cough
C)clubbing of the fingers
D)excess sputum with varying amounts of black fluid

Question 10

The nurse is caring for a patient on mechanical ventilation with positive end expiratory pressure (PEEP). When assessing the patient, which of the following findings would indicate the possibility of tension pneumothorax?

A)new onset of decreased breath sounds over the right lung
B)blood pressure of 170/80
C)pulse oximetry readings ranging from 94 to 96%
D)crackles and wheezing heard in both lungs

Question 11

The nurse, preparing instruction for a patient diagnosed with bacterial pneumonia, would expect which of the following classes of medication to be prescribed? Select all that apply.

A)antibiotics
B)steroids
C)bronchodilators
D)antiemetics
E)antihistamines

Question 12

Select the statement that indicates that a patient diagnosed with asthma needs additional teaching at discharge. Select all that apply.

A)"I know I shouldn't smoke, but one or two cigarettes a day shouldn't be harmful."
B)"I should monitor my peak flow daily and record it in a diary."
C)"I should rinse my mouth after each use of my corticosteroid inhaler."
D)"Using a spacer with my inhaler will allow for better and more accurate medication delivery."
E)"I can also use some herbal remedies I've read about to manage my symptoms."

Question 13

A patient diagnosed with tuberculosis is prescribed ethambutol (Myambutol). Prior to initiating this medication, the nurse should instruct the patient on which of the following?

A)if the patient has an allergy to eggs
B)having a baseline visual exam
C)having an influenza (flu) vaccine
D)having a baseline ECG (electrocardiogram)

Question 14

The nurse is providing teaching to a patient prescribed isoniazide (INH). Select the patient statement that indicates a need for further medication instruction.

A)"I will take the INH ? hour after eating breakfast."
B)"I will make sure I tell all my health care providers that I am taking INH."
C)"Tuna fish is one of my favorite foods.I will hate having to give it up."
D)"I will make sure I get my laboratory tests drawn to monitor my liver function."

Question 15

The nurse, caring for a patient diagnosed with lung cancer, determines that the patient might be experiencing superior vena cava syndrome when which of the following is assessed?

A)face and neck swelling
B)hourly urine outputs 250 to 500 mL
C)calcium level of 14.0 mg/dL
D)flat jugular veins

Question 16

Which of the following patients would the nurse identify as being at risk for developing cor pulmonale? Select all that apply.

A)patient with left ventricular heart failure
B)patient experiencing a massive pulmonary embolism
C)patient with chronic obstructive pulmonary disease (COPD)
D)patient with polycythemia vera
E)patient with deep vein thrombosis

Question 17

A patient with chronic obstructive lung disease tells the nurse that he does not always wear the prescribed oxygen at home because it is cumbersome and he is rarely short of breath. Which of the following is the nurse's best response to this patient?

A)"Wearing the oxygen will help keep your blood oxygen saturation levels up so your heart does not have to work at hard and will not become enlarged."
B)"You really should wear it at least while sleeping."
C)"It seems like you are doing fine without it."
D)"Keep the oxygen at home and if you become short of breath, you know to put it on until you are able to breath normally again."

Question 18

The nurse should instruct a patient who is prescribed INH and rifampin for the treatment of tuberculosis to report which of the following side effects? Select all that apply.

A)fever
B)yellow tint to the skin
C)episodic pain in the upper-left quadrant
D)diarrhea
E)change in stool color

Question 19

After a chest tube is inserted into a patient with a pneumothorax, which of the following should the nurse assess in the drainage system?

A)bubbling in the water seal chamber immediately after insertion
B)no evidence of tidaling
C)vigorous bubbling in the suction control chamber
D)large amount of bloody drainage in the drainage collection chamber

Question 20

A patient, diagnosed with chronic bronchitis, has the nursing diagnosis Ineffective Airway Clearance related to inadequate cough and excess mucous production. Which of the following interventions is of the least value in resolving the nursing diagnosis?

A)Check the pulse oximetry reading.
B)Increase fluid intake up to 2 liters/day.
C)Suction the patient.
D)Provide chest physiotherapy.

Question 21

A patient is diagnosed with histoplasmosis. Which of the following elements of this patient's history would help explain the reason for the disease?

A)lives in a city with chemical plants
B)drives a vehicle that uses diesel fuel
C)is an electrical engineer
D)works part-time for his grandparents' fresh poultry business

Question 22

A patient who is in the hospital is diagnosed with sudden acute respiratory syndrome (SARS). The best nursing intervention for this patient is to implement which of the following?

A)standard precautions
B)standard precautions and droplet precautions
C)standard precautions and contact precautions
D)standard, contact, and airborne precautions

Question 23

The nurse is providing care to a patient with pulmonary tuberculosis. Which of the following should the nurse do to ensure personal protection while caring for this patient?

A)Wear a gown and eye goggles.
B)Wear a gown and surgical mask.
C)Wear a gown and HEPA mask.
D)Wear a gown and sterile gloves.

Question 24

A patient with a lung abscess is being discharged from the hospital. Appropriate discharge instructions for this patient should include which of the following?

A)complete the entire prescription of antibiotics
B)expect symptoms to become worse.
C)return to routine activities of daily living.
D)lung abscesses rarely cause other problems once treatment is started.

Question 25

A patient tells the nurse he had the bacilli Calmette-Guérin (BCG) vaccination as a child because his mother had tuberculosis. This patient will be screened for tuberculosis by doing which of the following?

A)conducting a tine test
B)conducting a Mantoux test
C)conducting both the tine and Mantoux tests
D)conducting a chest x-ray

Question 26

A 20-year-old patient who is asking questions about smoking cessation tells the nurse about an upcoming class on scuba diving. The nurse identifies that this patient might be at risk for developing which of the following?

A)pleural effusion
B)pleurisy
C)pneumothorax
D)hemothorax

Question 27

A patient with lung cancer is demonstrating signs of complete tumor response after two courses of chemotherapy. The nurse concludes that this response is which of the following?

A)good for a long-term survival from the disease
B)an indication that radiation therapy is needed
C)an indication that surgery can be performed
D)a contraindication for further chemotherapy

Question 28

A patient who was admitted with symptoms of hypoxia is changed from a face mask to a nasal cannula for oxygen delivery. The nurse realizes that this patient's condition is

A)deteriorating.
B)improving.
C)stabilizing.
D)compounded with another health issue.

Question 29

A patient who is on isoniazid (INH) for pulmonary tuberculosis tells the nurse he doesn't like taking the medication because it makes his "fingers burn." The nurse concludes that the patient is experiencing which of the following?

A)a common side effect of isoniazid (INH) that will go away after completing the medication
B)a common side effect of isoniazid (INH) that can be treated with pyridoxine
C)a long-term complication of isoniazid (INH) that has no treatment
D)a common complication of isoniazid (INH) that can be treated with vitamin B₁₂ injections

Question 30

A patient states, "I've been sick for days and all the doctor does is take a chest x-ray, hand me prescriptions, and tell me I have bronchitis." The nurse realizes that this patient's treatment

A)is appropriate for the diagnosis.
B)should include more diagnostic tests.
C)is inadequate for the diagnosis of bronchitis.
D)should include hospitalization.

Question 31

During the assessment of a patient's respiratory status, the nurse notes paradoxical lung movements. This finding is consistent with which of the following?

A)flail chest
B)pleurisy
C)pneumothorax
D)pneumonia

Question 32

A patient who is receiving radiation therapy for lung cancer complains of ongoing fatigue. Appropriate teaching for this patient includes that

A)this is a complication of radiation therapy and will continue for years.
B)there is nothing that can help the fatigue
C)frequent rest periods and good nutrition can help with the fatigue.
D)restricting caloric intake often helps with the fatigue.

Question 33

A patient who is taking rifampin (Rifadin) as part of his treatment for tuberculosis asks about making an appointment for a urologist because his urine is "bright orange." The nurse realizes that this patient is experiencing which of the following?

A)a secondary urinary tract infection
B)a common side effect of rifampin therapy
C)the onset of a kidney stone
D)early renal failure

Question 34

The nurse is providing care to a patient with a differential diagnosis of carbon monoxide poisoning. Which of the following would be consistent with this diagnosis? Select all that apply.

A)cherry-red mucous membranes
B)circumoral pallor
C)diarrhea
D)nausea
E)dizziness

Question 35

The nurse observes air bubbles in a patient's chest tube water seal chamber. The nurse interprets this finding as which of the following?

A)normal
B)an emergency
C)an indication that the pneumothorax is worsening
D)an indication to remove the chest tube

Question 36

A patient who had a Mantoux test for tuberculosis two days ago has a 2 mm area of erythema at the site of the test. The nurse concludes that this patient's response

A)is negative.
B)is positive for tuberculosis.
C)should be followed up with a tine test.
D)is unable to determine the presence of tuberculosis.

Question 37

A patient is diagnosed with a tension pneumothorax. Which of the following would be consistent with this diagnosis? Select all that apply.

A)hypertension
B)distended neck veins
C)bradycardia
D)absent breath sounds on the affected side
E)tracheal deviation toward unaffected side

Question 38

The young child has been diagnosed with pneumonia and has been prescribed erythromycin, 45 mg per day for every 1 kilogram of body weight. The patient weighs 46 pounds. The physician asks that the patient receive the medication in three equal doses throughout the day. Calculate how much medication the patient should receive per each dose. Round the final answer to a whole number. ____ mg

Question 39

A patient is diagnosed with pleurisy. The nurse instructs the patient to alleviate the associated chest pain by which of the following?

A)only taking the prescribed analgesic when the pain is severe
B)teaching the patient how to splint the affected area when coughing
C)advising the patient to maintain bed rest
D)warning the patient to expect a fever to develop

Question 40

A patient who is diagnosed with primary atypical pneumonia tells the nurse that he "doesn't feel too sick." The nurse's best response is which of the following?

A)"Give it a few days and you will."
B)"You're lucky."
C)"You must be recovering from the illness."
D)"This type of pneumonia is usually mild in its effects."

Question 41

The patient undergoing chest physiotherapy is positioned for postural drainage of what areas of the lungs? Indicatewith an "X" on the diagram.

Question 42

The patient has developed pulmonary tuberculosis. Rank the following findings in order of occurrence based on the normal progression of this disease. Click and drag the options below to move them up or down.

A)The patient visits the physician's office with complaints of fatigue, night sweats, and has lost 10 pounds over the last 3 months.
B)The patient's purified protein derivative test is positive.The patient develops a cough with blood-tinged sputum.A chest x-ray indicates the presence of a cavitary lesion.
C)The patient is admitted to the hospital for treatment of pulmonary tuberculosis.
D)The patient begins to feel better.
E)The patient does not complain of any symptoms associated with pulmonary tuberculosis.

Question 43

The student nurse is learning about how to care for patients who have had thoracic surgery following a diagnosis of lung cancer. The intensive care unit nurse is assessing the student's understanding. Which of the following statements by the student indicates the need for further education? Select all that apply.

A)"I should assess the patient's respiratory system at least every four hours."
B)"I really shouldn't even offer narcotic pain medications to this patient because it will result in severe respiratory depression."
C)"If there are items that the patient needs frequently, I should keep them across the hospital room.This will ensure that the patient will get better faster."
D)"The patient's head of bed should be maintained between 15 and 30 degrees."
E)"The area between the visceral and parietal pleura must be filled with positive pressure to work appropriately and this can be accomplished with a functioning chest tube."

Question 44

The nurse has been reviewing research regarding the mortality rates of patients who have been infected with inhalation anthrax. If nine patients were infected with inhalation anthrax, how many patients would ultimately die even if they received the appropriate treatment? Round to the nearest whole number. ______

Question 45

$$\begin{array} { | l | l | } \hline \text { Diagnostic Test } & \text { Results } \\\hline \text { ELISA } & \text { Coronavirus identified } \\\hline \text { Chest x-ray } & \text { Consolidation evident in lower-left lung } \\\hline \text { Oxygen saturation level } & 89 \% \text { on room air } \\\hline \text { White blood cells with differential } & 2,000 / \mathrm { mm } ^ { 3 } , \text { lymphocytes decreased } \\\hline \text { Sputum culture } & \text { No organisms present } \\\hline\end{array}$$

-The nurse is reviewing the patient's diagnostic test results from the time of admission. Based on the chart above, which of the following statements made by the patient indicates that the patient requires further education?

A)"I have to be in isolation so that I won't infect anyone else."
B)"I'm surprised that the hospital has to report this to the health department."
C)"Adults have the worst time with the disease when compared to kids."
D)"Just go ahead and give me an antibiotic so that I can get on with my life."

Question 46

$$\begin{array} { | l | l | } \hline \text { Diagnostic Tests } & \text { Results } \\\hline \text { White blood cells with differential } & 32,000 / \mathrm { mm } ^ { 3 } \text {, left shift present } \\\hline \text { Chest x-ray } & \text { Lower-right lung, infiltrate present } \\\hline \text { Sputum culture } & \text { Staphylococcus aureus } \\\hline \text { Oxygen saturation level } & 88 \% \text { when admitted to hospital, on room air } \\\hline \text { Temperature } & 102.2 ^ { \circ } \mathrm { F } \\\hline \text { Respiratory rate } & 28 \text { per minute } \\\hline\end{array}$$

-The nurse is reviewing the results of the patient's diagnostic tests. Based on the chart above, which of the following physician orders would the nurse most likely

A)fluid restriction of 1500 mL per 24 hours
B)administer acetylcysteine (Mucomyst)
C)perform endotracheal suctioning as needed
D)administer azithromycin