Question 1

The nurse is assessing a patient with chronic obstructive pulmonary disease (COPD).Which assessment finding indicates a potential complication and requires the nurse's immediate attention?

Accepted Answer

Cor pulmonale is enlargement of the right side of the heart as a result of pulmonary hypertension caused by constriction of the pulmonary vessels in response to hypoxia.Constant hypoxia stimulates erythropoiesis,with resulting polycythemia and increased viscosity of blood.Eventually,right-sided heart failure causes systemic venous congestion which manifests with distended neck veins.The patient would experience right upper quadrant tenderness from an engorged liver.Urinary output of 40 mL/hr is normal.Excessive coughing does not indicate an urgent complication.

Question 2

The patient with acute bronchitis asks if antibiotics will be ordered for the condition.Which response is best for the nurse to make?

Accepted Answer

Bronchitis is treated symptomatically with humidification and cough medications.Antibiotics are only given if the sputum culture suggests it.

Question 3

The patient with asthma is prescribed a leukotriene modifier drug,montelukast (Singulair).Which statement describes an advantage of this medication?

Accepted Answer

Singulair provides both bronchodilation and anti-inflammatory effects,but it has numerous GI side effects and is not effective in controlling acute asthmatic attacks.

Question 4

The 75-year-old patient asks the nurse if the Pneumovax immunization he took when he was 65 is still protecting him.Which reply is most accurate?

Accepted Answer

Pneumovax,an immunization that protects against 23 pneumococcal organisms,is repeated 6 years after the first dose.

Question 5

The nurse is caring for a 30-year-old American Indian female who is taking Rifater,a drug containing rifampin,isoniazid,and pyrazinamide.The patient asks how long she will have to take the medication.Which response explains when the patient may discontinue the medication?

Accepted Answer

This drug is given to treat active tuberculosis (TB).The active TB patient is considered noncontagious when three consecutive sputum cultures are negative.Taking the medication for a given period of time does not make the patient noncontagious.The TST will always be positive.

Question 6

The 79-year-old patient with bacterial pneumonia becomes increasingly restless,confused,and agitated.The patient's temperature is 100° F,and his pulse,blood pressure,and respirations are elevated since the last assessment 6 hours ago.What action should the nurse take first?

Accepted Answer

Outward signs of hypoxia vary in patients,but dyspnea,restlessness,and confusion are the most common signs.While blood gas analysis is the most reliable indicator,bedside assessment pulse oximetry is quick,noninvasive,and gives a snapshot of oxygen saturation.The nurse should auscultate the patient's lungs after obtaining the oxygen saturation.Medications for sedation or discomfort do not address the patient's current condition.

Question 7

The nurse reading a tuberculin skin test (TST)on a new employee who lives in the Midwest,is 20-years-old,and has no known history of contact with any people with tuberculosis (TB).The nurse should interpret the reading as positive if the area around the injection site has an induration of how many millimeters?

Accepted Answer

All TSTs are read at 48 to 72 hours after the injection.A positive reading of a TST for a person who is low risk for exposure is an area of swelling 15 mm or more.For individuals who are at high risk for TB (such as recent immigrants from countries where TB is prevalent,medically underserved groups,and the homeless),swelling of more than 10 mm is considered positive.Individuals with a history of contact with infectious TB or who are immunocompromised are considered to have a positive TST if there is more than 5 mm of swelling.

Question 8

After using a nasal cannula delivery system at 3 L/min,a patient with chronic airflow limitation (CAL)changes to a simple face mask.The nasal equipment oxygen was set at 3 L/min.How should the nurse adjust the oxygen flow for the new delivery system?

Accepted Answer

When changing to a mask from a nasal cannula,the oxygen should be increased by approximately 100% to get the same concentration.Simple face masks deliver approximately the same range of concentration of oxygen as the nasal cannula.However,the nasal cannula flow rates range from 1 to 6 L,delivering 24% to 44% oxygen,whereas the simple face mask delivers 35% to 50% oxygen which is achieved with flow rates from 6 to 12 L.

Question 9

The 75-year-old patient presents to the emergency department with shortness of breath,fatigue,and a dry cough.When information leads the nurse to suspect that this patient should undergo workup for histoplasmosis?

Accepted Answer

Histoplasmosis is caused by a fungus that lives in bird droppings.Contact with chickens coupled with the characteristic signs of dry cough,shortness of breath,and fatigue warrants a workup for histoplasmosis.Legionellosis is a bacterial infection contracted from contaminated drinking water.Rocky Mountain spotted fever and lime disease are transmitted by ticks found in wooded areas.Coccidioidomycosis is contracted by people who engage in desert recreational activities or are working in occupations that require digging in the earth.

Question 10

The nurse is educating a patient who requires daily postural drainage treatments.Which statement indicates that the patient understands when and why treatments will be scheduled?

Accepted Answer

If the patient is to have postural drainage only once a day,drainage should be done in the morning to remove secretions that have accumulated during the night.Because there is likely to be some gagging during coughing episodes that take place during postural drainage,it is best to carry out the procedure before meals,when the stomach is relatively empty and vomiting is less likely.

Question 11

Through which method(s)can influenza spread?

Accepted Answer

Influenza spreads through direct and indirect contact from droplets.Influenza is not spread by vectors or the blood-borne method.

Question 12

The nurse is caring for a patient with suspected bacterial pneumonia.Which finding supports the potential diagnosis?

Accepted Answer

Viral pneumonia causes interstitial inflammation with attendant edema.White blood cell (WBC)count will not be elevated and no exudate is consolidating the lung as with bacterial pneumonia.

Question 13

What is the purpose of treatment with amantadine (Symmetrel)?

Accepted Answer

Amantadine (Symmetrel)is an antiviral medication that may be given within 48 hours of exposure or within 48 hours of the onset of influenza symptoms.It is not a drug that is taken regularly and will not stop the spread of the avian flu.

Question 14

The nurse is caring for a patient with a closed-chest drainage system with chest tubes.Which observation confirms that the system is intact and working?

Accepted Answer

If the level of the water in the water-seal chamber rises and falls with the patient's respiration,the system is intact.Constant bubbles in the water-seal chamber indicate a leak in the system.The fluid in the collection container drains by gravity whether the closed-chest drainage system is intact or not.Suction is not significant with respect to whether the system is intact.

Question 15

The nurse is caring for a first-day postoperative thoracotomy patient.The nurse assesses that the level of drainage has not increased over the last 3 hours.After assessing the patient's respiratory status,what should the nurse do next?

Accepted Answer

After assessing the patient's respiratory status,the nurse should ensure that the tubing is not kinked or obstructed by the weight of the patient.The nurse should then check the apparatus; all connections should be taped,be intact,and remain airtight.The system must be below the level of the patient's heart.The nurse should also double-check the physician's order for patient position,and reposition as needed.Finally,the nurse should report the findings to the RN or physician.

Question 16

The patient with sleep apnea is fitted with a continuous positive airway pressure (CPAP)mask and asks the nurse how this device will help.How should the nurse respond?

Accepted Answer

The CPAP mask delivers a constant positive pressure to keep the airway open.CPAP does not require intubation and does not deliver negative pressure.

Question 17

The nurse is caring for a patient immediately postoperative after a left pneumonectomy.How should the nurse position the patient?

Accepted Answer

Postoperative positioning after a pneumonectomy is on the operated side to prevent the threat of tension pneumothorax with mediastinal shift and leakage from the amputated bronchial stump.The physician's order should always be checked before turning the patient or raising the head of the bed.

Question 18

The nurse is assessing the patient with influenza.The patient reports having general malaise and aching muscles over the past 2 weeks.The nurse suspects that the patient may have developed which complication of influenza?

Accepted Answer

Bacterial pneumonia is a common complication of influenza and may present with atypical symptoms of only general malaise and muscle aches,making it difficult to recognize the symptoms of pneumonia.Bronchitis,urinary infections,and encephalitis are not common complications of influenza.

Question 19

When caring for a patient with acquired immune deficiency syndrome (AIDS),the nurse is aware that this patient is most at risk for developing which type of pneumonia?

Accepted Answer

Pneumocystis jiroveci (formerly known as Pneumocystis carinii)is commonly seen in AIDS patients.Hypostatic pneumonia is related to inadequate aeration of the lungs seen frequently with immobile patients.Streptococcus pneumoniae is the most common causative organism for bacterial pneumonia in the general population.Atypical pneumonia refers to pneumonia that does not present with the typical symptoms of pneumonia.

Question 20

The nurse is educating an asthma patient about proper use of the peak flowmeter.The nurse determines that the patient needs further teaching when observing which action?

Accepted Answer

Peak flow should be monitored on a daily basis to determine if the asthma patient has adequate airflow.The reading helps determine if treatment should be adjusted.The patient should stand to achieve adequate chest expansion while taking a deep breath.The patient then blows as hard and fast as possible into the device with the mouthpiece in the mouth and the lips clamped firmly around it for a tight seal.The procedure should be performed three times with the highest reading recorded.

Quiz 14: Care of Patients with Disorders of the Lower Respiratory System

The nurse is assessing a patient with chronic obstructive pulmonary disease (COPD) .Which assessment finding indicates a potential complication and requires the nurse's immediate attention?

The patient with acute bronchitis asks if antibiotics will be ordered for the condition.Which response is best for the nurse to make?

The patient with asthma is prescribed a leukotriene modifier drug,montelukast (Singulair) .Which statement describes an advantage of this medication?

The 75-year-old patient asks the nurse if the Pneumovax immunization he took when he was 65 is still protecting him.Which reply is most accurate?

The nurse is caring for a 30-year-old American Indian female who is taking Rifater,a drug containing rifampin,isoniazid,and pyrazinamide.The patient asks how long she will have to take the medication.Which response explains when the patient may discontinue the medication?

The 79-year-old patient with bacterial pneumonia becomes increasingly restless,confused,and agitated.The patient's temperature is 100° F,and his pulse,blood pressure,and respirations are elevated since the last assessment 6 hours ago.What action should the nurse take first?

After using a nasal cannula delivery system at 3 L/min,a patient with chronic airflow limitation (CAL) changes to a simple face mask.The nasal equipment oxygen was set at 3 L/min.How should the nurse adjust the oxygen flow for the new delivery system?

The 75-year-old patient presents to the emergency department with shortness of breath,fatigue,and a dry cough.When information leads the nurse to suspect that this patient should undergo workup for histoplasmosis?

The nurse is educating a patient who requires daily postural drainage treatments.Which statement indicates that the patient understands when and why treatments will be scheduled?

Through which method(s) can influenza spread?

The nurse is caring for a patient with suspected bacterial pneumonia.Which finding supports the potential diagnosis?

What is the purpose of treatment with amantadine (Symmetrel) ?

The nurse is caring for a patient with a closed-chest drainage system with chest tubes.Which observation confirms that the system is intact and working?

The nurse is caring for a first-day postoperative thoracotomy patient.The nurse assesses that the level of drainage has not increased over the last 3 hours.After assessing the patient's respiratory status,what should the nurse do next?

The patient with sleep apnea is fitted with a continuous positive airway pressure (CPAP) mask and asks the nurse how this device will help.How should the nurse respond?

The nurse is caring for a patient immediately postoperative after a left pneumonectomy.How should the nurse position the patient?

The nurse is assessing the patient with influenza.The patient reports having general malaise and aching muscles over the past 2 weeks.The nurse suspects that the patient may have developed which complication of influenza?

When caring for a patient with acquired immune deficiency syndrome (AIDS) ,the nurse is aware that this patient is most at risk for developing which type of pneumonia?

The nurse is educating an asthma patient about proper use of the peak flowmeter.The nurse determines that the patient needs further teaching when observing which action?