Deck 36: Nursing Care of Patients With Ventilation Disorders

Question 1

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.

Answer 1

is negative.

Question 2

The nurse is caring for a patient diagnosed with severe acute respiratory syndrome (SARS). For what conditions should the nurse assess in this patient?

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

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

A) "I will take the INH immediately after eating breakfast."
B) "I will make sure I tell all my healthcare providers that I am taking INH."
C) "Although I love beer, I will give it up while taking this medication."
D) "I will make sure I get my laboratory tests drawn to monitor my liver function."

Answer 3

"I will take the INH immediately after eating breakfast."

Question 4

A patient diagnosed with tuberculosis is prescribed ethambutol (EMB). Prior to initiating this medication, what should the nurse instruct the patient?

A) Avoid this medication if allergic to eggs.
B) Have a baseline visual exam.
C) Have an influenza (flu) vaccination.
D) Have a baseline ECG (electrocardiogram).

Question 5

A patient has a chest tube inserted for a pneumothorax. What should the nurse expect when assessing the drainage system?

A) periodic 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 6

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

A) new onset of absent 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 7

A patient with a lung abscess is being discharged from the hospital. What should be included in this patient's discharge instructions?

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 8

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 effect?

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 9

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 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 10

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 11

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

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

Question 12

A hospitalied patient is diagnosed with sudden acute respiratory syndrome (SARS). What action should the nurse implement immediately?

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

Question 13

A patient with pneumonia is having difficulty maintaining a clear airway. Which actions should the nurse take to ensure this patient is adequately ventilated?

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 14

The nurse is caring for a patient with bacterial pneumonia. Which classifications of medications should the nurse expect to be prescribed for this patient?

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

Question 15

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 16

A patient who is diagnosed with primary atypical pneumonia tells the nurse that he "doesn't feel too sick." What would be the nurse's best response?

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 17

The nurse is assessing a patient recovering from a motor vehicle crash. Which assessment finding indicates that the patient 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

Question 18

A patient tells the nurse he had the bacilli Calmette-Guérin (BCG) vaccination as a child because his mother had tuberculosis. How should the nurse expect this patient to be screened for tuberculosis?

A) tine test
B) Mantoux test
C) tine and Mantoux tests
D) chest x-ray

Question 19

A patient is prescribed isoniazid (INH) and rifampin for treatment of tuberculosis. Which adverse effects should the nurse instruct the patient to report to the healthcare provider?

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

Question 20

The nurse caring for a patient diagnosed with lung cancer determines that the patient might be experiencing superior vena cava syndrome. What did the nurse assess to make this clinical decision?

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 21

A patient with lung cancer is demonstrating signs of complete tumor response after two courses of chemotherapy. What should the nurse conclude that this response indicates?

A) 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 22

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

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

Question 23

A patient is diagnosed with histoplasmosis. What element 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 on a chicken farm

Question 24

The nurse is reviewing the results of the patient's diagnostic tests. Using the information provided as a reference, determine which physician order the nurse should $$\begin{array} { | l | l | } \hline \text { Diagnostic Tests } & \text { Results } \\\hline \text { White blood cells with differential } & 32,000 / \mathrm { mm } ^ { 3 } \text {, left shift present } \\\hline \text { Chest x-ray } & \text { Lower-right lung, infiltrate present } \\\hline \text { Sputum culture } & \text { Staphylococcus aureus } \\\hline \text { Oxygen saturation level } & 88 \% \text { when admitted to hospital, on room air } \\\hline \text { Temperature } & 102.2 ^ { \circ } \mathrm { F } \\\hline \text { Respiratory rate } & 28 \text { per minute } \\\hline\end{array}$$

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

Question 25

After an assessment the nurse is concerned that an older patient is at risk for developing pneumonia. What age-related changes did the nurse assess to make this clinical decision?

A) Weak cough
B) Poor skin turgor
C) Smoked a ppd for 30 years
D) Body mass index 22.6
E) Diagnosed with right-sided heart failure

Question 26

A young child diagnosed with pneumonia 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 ____ mg

Question 27

A patient is diagnosed with pleurisy. What should the nurse suggest to the patient to alleviate the associated chest pain from this disorder?

A) instructing the patient to take the prescribed analgesic only 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 28

A patient is diagnosed with a tension pneumothorax. What should the nurse expect to assess in this patient?

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

Question 29

A patient has developed pulmonary tuberculosis. Rank the findings in order of occurrence based on the normal progression of this disease.

A) The patient begins to feel better.
B) The patient is admitted to the hospital for treatment of pulmonary tuberculosis.
C) The patient does not complain of any symptoms associated with pulmonary tuberculosis.
D) The patient visits the physician's office with complaints of fatigue, night sweats, and has lost 10 pounds over the last 3 months.
E) 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.
F) none of the above

Question 30

The nurse places a patient in the position illustrated. Which lung area is the nurse focusing for postural drainage? Indicate with an "X" on the diagram.

Question 31

The nurse observes air bubbles in a patient's chest tube water seal chamber. How should the nurse interpret this finding?

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

Question 32

The nurse is caring for victims of bioterrorism who were exposed to inhalation anthrax. After assessment, it is determined that 350 people were exposed to the potentially deadly spore. Knowing that this disease has a 45% mortality rate, how many patients should the nurse expect to recover from this illness?

Question 33

The nurse is reviewing the diagnostic test results from the time of admission with the patient. Which statement indicates that the patient requires further education about the health problem, judging from the information provided? $$\begin{array} {| l | l |} \hline \text { Diagnostic Test } & \text { Results } \\\hline \text { ELISA } & \text { Coronavirus identified } \\\hline \text { Chest x-ray } & \text { Consolidation evident in lower-left lung } \\\hline \text { Oxygen saturation level } & 89 \% \text { on room air } \\\hline \text { White blood cells with differential } & 2,000 / \mathrm { mm } ^ { 3 } , \text { lymphocytes decreased } \\\hline \text { Sputum culture } & \text { No organisms present }\\\hline\end{array}$$

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 a worse time with the disease than kids do."
D) "Just go ahead and give me an antibiotic so that I can get on with my life."

Question 34

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

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 35

The nurse is providing care to a patient with pulmonary tuberculosis. What 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 36

A patient who is receiving radiation therapy for lung cancer complains of ongoing fatigue. What should be included in the teaching for this patient?

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 37

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." What should the nurse realize this patient is experiencing?

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 38

The nurse is providing care to a patient with a differential diagnosis of carbon monoxide poisoning. Which assessment findings would be consistent with this diagnosis?

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

Question 39

After reviewing the medical history, the nurse suspects that a 68-year-old patient would benefit from another dose of the pneumococcus vaccination. What information did the nurse use to make this clinical decision?

A) Initial vaccination at age 55
B) Taking medications for hypertension
C) Ongoing treatment for prostate cancer
D) History of two hip replacement surgeries
E) Beginning dialysis for chronic renal failure

Question 40

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

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

Question 41

The nurse is preparing a patient for a thoracentesis to drain an empyema. What should the nurse instruct the patient about this procedure?

A) You will have a chest x-ray after the procedure.
B) You will lie on the unaffected side for 1 hour after the procedure.
C) You will have general anesthesia for pain control during the procedure.
D) You will be seated, learning forward with arms and head supported with an overbed table.
E) You will be permitted to resume normal activities after 1 hour if no evidence of adverse effects occurs.

Question 42

The nurse is reviewing orders written for a patient being treated for Legionella pneumophila. Which antibiotics should the nurse expect to be prescribed for this patient?

A) rifampin
B) macrolide
C) prednisone
D) erythromycin
E) fluoroquinolone

Question 43

The nurse is preparing to assess a patient admitted for treatment of bilateral pleural effusions. On what should the nurse focus when assessing this patient?

A) Urine output
B) Cardiac rate and rhythm
C) Joint function and mobility
D) Muscle tone and movement
E) Peripheral pulses and edema