Question 1

Following assessment of a patient with pneumonia,the nurse identifies a nursing diagnosis of ineffective airway clearance.Which assessment data best supports this diagnosis?

Accepted Answer

The weak,nonproductive cough indicates that the patient is unable to clear the airway effectively.The other data would be used to support diagnoses such as impaired gas exchange and ineffective breathing pattern.

Question 2

Employee health test results reveal a tuberculosis (TB)skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit.The nurse has no symptoms of TB.Which information should the occupational health nurse plan to teach the staff nurse?

Accepted Answer

The nurse is considered to have a latent TB infection and should be treated with INH daily for 6 to 9 months.The four-drug therapy would be appropriate if the nurse had active TB.TB skin testing is not done for individuals who have already had a positive skin test.BCG vaccine is not used in the United States for TB and would not be helpful for this individual,who already has a TB infection.

Question 3

A patient with newly diagnosed lung cancer tells the nurse,"I don't think I'm going to live to see my next birthday." Which response by the nurse is best?

Accepted Answer

The nurse's initial response should be to collect more assessment data about the patient's statement.The answer beginning "Can you tell me what it is" is the most open-ended question and will offer the best opportunity for obtaining more data.The answer beginning,"Are you afraid" implies that the patient thinks that the cancer will be immediately fatal,although the patient's statement may not be related to the cancer diagnosis.The remaining two answers offer interventions that may be helpful to the patient,but more assessment is needed to determine whether these interventions are appropriate.

Question 4

An hour after a thoracotomy,a patient complains of incisional pain at a level 7 (based on 0 to 10 scale)and has decreased left-sided breath sounds.The pleural drainage system has 100 mL of bloody drainage and a large air leak.Which action is best for the nurse to take next?

Accepted Answer

The patient is unlikely to take deep breaths or cough until the pain level is lower.A chest tube output of 100 mL is not unusual in the first hour after thoracotomy and would not require milking of the chest tube.An air leak is expected in the initial postoperative period after thoracotomy.

Question 5

A patient with bacterial pneumonia has rhonchi and thick sputum.What is the nurse's most appropriate action to promote airway clearance?

Accepted Answer

Coughing is less painful and more likely to be effective when the patient splints the chest during coughing.Fluids should be encouraged to help liquefy secretions.Nasal oxygen will improve gas exchange,but will not improve airway clearance.Pursed lip breathing is used to improve gas exchange in patients with COPD,but will not improve airway clearance.

Question 6

The nurse provides discharge instructions to a patient who was hospitalized for pneumonia.Which statement,if made by the patient,indicates a good understanding of the instructions?

Accepted Answer

Patients should continue to cough and deep breathe after discharge.Fatigue is expected for several weeks.The Pneumovax and influenza vaccines can be given at the same time in different arms.Explain that a follow-up chest x-ray needs to be done in 6 to 8 weeks to evaluate resolution of pneumonia.

Question 7

An occupational health nurse works at a manufacturing plant where there is potential exposure to inhaled dust.Which action,if recommended by the nurse,will be most helpful in reducing the incidence of lung disease?

Accepted Answer

Prevention of lung disease requires the use of appropriate protective equipment such as masks.The other actions will help in recognition or early treatment of lung disease but will not be effective in prevention of lung damage.Repeated exposure eventually results in diffuse pulmonary fibrosis.Fibrosis is the result of tissue repair after inflammation.

Question 8

The nurse teaches a patient about the transmission of pulmonary tuberculosis (TB).Which statement,if made by the patient,indicates that teaching was effective?

Accepted Answer

Teach the patient how to minimize exposure to close contacts and household members.Homes should be well ventilated,especially the areas where the infected person spends a lot of time.While still infectious,the patient should sleep alone,spend as much time as possible outdoors,and minimize time in congregate settings or on public transportation.

Question 9

The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test.Which action should the nurse take?

Accepted Answer

Sputum specimens are obtained on 2 to 3 consecutive days for bacteriologic testing for M.tuberculosis.The patient should not provide all the specimens at once.Blood cultures are not used for tuberculosis testing.A chest x-ray is not bacteriologic testing.Although the findings on chest x-ray examination are important,it is not possible to make a diagnosis of TB solely based on chest x-ray findings because other diseases can mimic the appearance of TB.

Question 10

After 2 months of tuberculosis (TB)treatment with isoniazid (INH),rifampin (Rifadin),pyrazinamide (PZA),and ethambutol,a patient continues to have positive sputum smears for acid-fast bacilli (AFB).Which action should the nurse take next?

Accepted Answer

The first action should be to determine whether the patient has been compliant with drug therapy because negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the medications have been taken correctly.Assessment is the first step in the nursing process.Depending on whether the patient has been compliant or not,different medications or directly observed therapy may be indicated.The other options are interventions based on assumptions until an assessment has been completed.

Question 11

An older patient is receiving standard multidrug therapy for tuberculosis (TB).The nurse should notify the health care provider if the patient exhibits which finding?

Accepted Answer

Noninfectious hepatitis is a toxic effect of isoniazid (INH),rifampin,and pyrazinamide,and patients who develop hepatotoxicity will need to use other medications.Changes in hearing and nail thickening are not expected with the four medications used for initial TB drug therapy.Presbycusis is an expected finding in the older adult patient.Orange discoloration of body fluids is an expected side effect of rifampin and not an indication to call the health care provider.

Question 12

The nurse develops a plan of care to prevent aspiration in a high-risk patient.Which nursing action will be most effective?

Accepted Answer

The risk for aspiration is decreased when patients with a decreased level of consciousness are placed in a side-lying or upright position.Frequent turning prevents pooling of secretions in immobilized patients but will not decrease the risk for aspiration in patients at risk.Monitoring of parameters such as breath sounds and oxygen saturation will help detect pneumonia in immunocompromised patients,but it will not decrease the risk for aspiration.Conditions that increase the risk of aspiration include decreased level of consciousness (e.g.,seizure,anesthesia,head injury,stroke,alcohol intake),difficulty swallowing,and nasogastric intubation with or without tube feeding.With loss of consciousness,the gag and cough reflexes are depressed,and aspiration is more likely to occur.Other high-risk groups are those who are seriously ill,have poor dentition,or are receiving acid-reducing medications.

Question 13

The clinic nurse teaches a patient with a 42 pack-year history of cigarette smoking about lung disease.Which information will be most important for the nurse to include?

Accepted Answer

Because smoking is the major cause of lung cancer,the most important role for the nurse is teaching patients about the benefits of and means of smoking cessation.CT scanning is currently being investigated as a screening test for high-risk patients.However,if there is a positive finding,the person already has lung cancer.Erlotinib may be used in patients who have lung cancer,but it is not used to reduce the risk of developing cancer.

Question 14

A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days.Which assessment data obtained by the nurse indicates that the treatment has been effective?

Accepted Answer

The normal WBC count indicates that the antibiotics have been effective.All the other data suggest that a change in treatment is needed.

Question 15

A lobectomy is scheduled for a patient with stage I non-small cell lung cancer.The patient tells the nurse,"I would rather have chemotherapy than surgery." Which response by the nurse is most appropriate?

Accepted Answer

More assessment of the patient's concerns about surgery is indicated.An open-ended response will elicit the most information from the patient.The answer beginning,"Surgery is the treatment of choice" is accurate,but it discourages the patient from sharing concerns about surgery.The remaining two answers indicate that the nurse has jumped to conclusions about the patient's reasons for not wanting surgery.Chemotherapy is the primary treatment for small cell lung cancer.In non-small cell lung cancer,chemotherapy may be used in the treatment of nonresectable tumors or as adjuvant therapy to surgery.

Question 16

A patient is admitted with active tuberculosis (TB).The nurse should question a health care provider's order to discontinue airborne precautions unless which assessment finding is documented?

Accepted Answer

Negative sputum smears indicate that Mycobacterium tuberculosis is not present in the sputum,and the patient cannot transmit the bacteria by the airborne route.Chest x-rays are not used to determine whether treatment has been successful.Taking medications for 6 months is necessary,but the multidrug-resistant forms of the disease might not be eradicated after 6 months of therapy.Repeat Mantoux testing would not be done because the result will not change even with effective treatment.

Question 17

The nurse assesses the chest of a patient with pneumococcal pneumonia.Which finding would the nurse expect?

Accepted Answer

Increased tactile fremitus over the area of pulmonary consolidation is expected with bacterial pneumonias.Dullness to percussion would be expected.Pneumococcal pneumonia typically presents with a loose,productive cough.Adventitious breath sounds such as crackles and wheezes are typical.A grating sound is more representative of a pleural friction rub rather than pneumonia.

Question 18

A patient who is taking rifampin (Rifadin)for tuberculosis calls the clinic and reports having orange discolored urine and tears.Which is the best response by the nurse?

Accepted Answer

Orange-colored body secretions are a side effect of rifampin.The patient does not have to stop taking the medication.The findings are not indicative of an allergic reaction.Alterations in red-green color discrimination commonly occurs when taking ethambutol (Myambutol),which is a different TB medication.

Question 19

When caring for a patient who is hospitalized with active tuberculosis (TB),the nurse observes a student nurse who is assigned to take care of a patient.Which action,if performed by the student nurse,would require an intervention by the nurse?

Accepted Answer

A high-efficiency particulate-absorbing (HEPA)mask,rather than a standard surgical mask,should be used when entering the patient's room because the HEPA mask can filter out 100% of small airborne particles.Hand washing before entering the patient's room is appropriate.Because anorexia and weight loss are frequent problems in patients with TB,bringing food to the patient is appropriate.The student nurse should perform hand washing after handling a tissue that the patient has used,but no precautions are necessary when giving the patient an unused tissue.

Question 20

An alcoholic and homeless patient is diagnosed with active tuberculosis (TB).Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen?

Accepted Answer

Directly observed therapy is the most effective means for ensuring compliance with the treatment regimen,and arranging a daily meal will help ensure that the patient is available to receive the medication.The other nursing interventions may be appropriate for some patients but are not likely to be as helpful for this patient.

Quiz 28: Nursing Management: Lower Respiratory Problems

Following assessment of a patient with pneumonia,the nurse identifies a nursing diagnosis of ineffective airway clearance.Which assessment data best supports this diagnosis?

Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit.The nurse has no symptoms of TB.Which information should the occupational health nurse plan to teach the staff nurse?

A patient with newly diagnosed lung cancer tells the nurse,"I don't think I'm going to live to see my next birthday." Which response by the nurse is best?

An hour after a thoracotomy,a patient complains of incisional pain at a level 7 (based on 0 to 10 scale) and has decreased left-sided breath sounds.The pleural drainage system has 100 mL of bloody drainage and a large air leak.Which action is best for the nurse to take next?

A patient with bacterial pneumonia has rhonchi and thick sputum.What is the nurse's most appropriate action to promote airway clearance?

The nurse provides discharge instructions to a patient who was hospitalized for pneumonia.Which statement,if made by the patient,indicates a good understanding of the instructions?

An occupational health nurse works at a manufacturing plant where there is potential exposure to inhaled dust.Which action,if recommended by the nurse,will be most helpful in reducing the incidence of lung disease?

The nurse teaches a patient about the transmission of pulmonary tuberculosis (TB) .Which statement,if made by the patient,indicates that teaching was effective?

The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test.Which action should the nurse take?

After 2 months of tuberculosis (TB) treatment with isoniazid (INH) ,rifampin (Rifadin) ,pyrazinamide (PZA) ,and ethambutol,a patient continues to have positive sputum smears for acid-fast bacilli (AFB) .Which action should the nurse take next?

An older patient is receiving standard multidrug therapy for tuberculosis (TB) .The nurse should notify the health care provider if the patient exhibits which finding?

The nurse develops a plan of care to prevent aspiration in a high-risk patient.Which nursing action will be most effective?

The clinic nurse teaches a patient with a 42 pack-year history of cigarette smoking about lung disease.Which information will be most important for the nurse to include?

A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days.Which assessment data obtained by the nurse indicates that the treatment has been effective?

A lobectomy is scheduled for a patient with stage I non-small cell lung cancer.The patient tells the nurse,"I would rather have chemotherapy than surgery." Which response by the nurse is most appropriate?

A patient is admitted with active tuberculosis (TB) .The nurse should question a health care provider's order to discontinue airborne precautions unless which assessment finding is documented?

The nurse assesses the chest of a patient with pneumococcal pneumonia.Which finding would the nurse expect?

A patient who is taking rifampin (Rifadin) for tuberculosis calls the clinic and reports having orange discolored urine and tears.Which is the best response by the nurse?

When caring for a patient who is hospitalized with active tuberculosis (TB) ,the nurse observes a student nurse who is assigned to take care of a patient.Which action,if performed by the student nurse,would require an intervention by the nurse?

An alcoholic and homeless patient is diagnosed with active tuberculosis (TB) .Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen?